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E-024 acute cerebral hemorrhage with arteriovenous malformation (avm): role of angiographic – ct (dyna cta)
  1. V Gupta1,
  2. G Goel1,
  3. R Parthasarathy1,
  4. A Gupta2,
  5. K Singh2,
  6. V Singhal3,
  7. A Jha2
  1. 1Neurointerventional Surgery, Medanta the-Medicity, Gurgaon, Sector 38, India
  2. 2Neurosurgery, Medanta the-Medicity, Gurgaon, Sector 38, India
  3. 3Neuroanaesthesia and Critical Care, Medanta the-Medicity, Gurgaon, Sector 38, India


Purpose In patients with hematoma associated with arteriovenous malformations (AVMs), it is critical to evaluate the angio-architecture of the malformation and determine the relationship of a peri or intra-nidal aneurysm to the hematoma. Combined angiography/CT suite that uses flat-panel detector (FD) technology provides with higher-resolution angiography and CT-like images (Angiographic-CT). We retrospectively reviewed cases of cerebral hematoma due to ruptured AVM in whom Angiographic CT was done.

Material and methods The imaging was acquired with selective intra-arterial injection of the vessel feeding the AVM. Post processing was performed in a workstation and images reviewed in all three planes. The imaging findings and the role of the technique in decision making were evaluated.

Results Ten patients [median age: 43 years (12–75); male 6(60%)] were evaluated with the technique. DSA images revealed possible peri/intranidal aneurysm in eight patients. The AVM nidus measured ≤3 cms in seven (70%, n = 10) and 4 cms in one patient. Angiographic CT examination revealed projection of aneurysm sac into the hematoma cavity thereby confirming the presence of a ruptured intra/perinidal aneurysm in seven patients. Suspected intranidal aneurysm on DSA was identified as a venous loop on AngioCT in one patient. In another case with feeding artery and venous aneurysm, it confirmed that the arterial aneurysm was the ruptured one by its relationship to the hematoma. In seven patients, the aneurysm and part of AVM were embolized in acute stage and was followed with radiosurgery or surgery for the residual AVM. Two patients were directly operated upon with excision of aneurysm, AVM and hematoma. One patient awaits treatment. AngioCT was useful to determine the relationship of the feeding arteries and draining veins with the AVM and to plan the surgical approach. In one patient with very small AVM, the Angiographic-CT images were used for neuronavigation during surgery.

Conclusion Angiographic-CT with intra-arterial injection is a useful adjunct to cerebral angiography in evaluating patients with cerebral hematoma due to ruptured AVMs. It is more accurate than DSA to localize and confirm intra/perinidal aneurysms, delineating relationship of hematoma and AVM and for image guidance during surgery.

Abstract E-024 Figure 1

A – DSA image showing AVM nidus with multiple areas of aneurysmal dilatation (arrows). B – Angio-CT image showing the aneurysm (arrow) in the wall of the hematoma. This aneurysm represented the aneurysm marked by black arrow in image A. Embolization was performed to occlude the probable site of rupture

Disclosures V. Gupta: None. G. Goel: None. R. Parthasarathy: None. A. Gupta: None. K. Singh: None. V. Singhal: None. A. Jha: None.

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