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Titolo:
Perimesencephalic hemorrhage and CT angiography - A decision analysis
Autore:
Ruigrok, YM; Rinkel, GJE; Buskens, E; Velthuis, BK; van Gijn, J;
Indirizzi:
Univ Utrecht, Med Ctr, Dept Neurol, NL-3500 GA Utrecht, Netherlands Univ Utrecht Utrecht Netherlands NL-3500 GA 3500 GA Utrecht, Netherlands Univ Utrecht, Med Ctr, Julius Ctr Patient Oriented Res, NL-3500 GA Utrecht, Netherlands Univ Utrecht Utrecht Netherlands NL-3500 GA 3500 GA Utrecht, Netherlands Univ Utrecht, Med Ctr, Dept Radiol, NL-3500 GA Utrecht, Netherlands Univ Utrecht Utrecht Netherlands NL-3500 GA 3500 GA Utrecht, Netherlands
Titolo Testata:
STROKE
fascicolo: 12, volume: 31, anno: 2000,
pagine: 2976 - 2983
SICI:
0039-2499(200012)31:12<2976:PHACA->2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
NONANEURYSMAL SUBARACHNOID HEMORRHAGE; QUALITY-OF-LIFE; VERTEBROBASILAR ANEURYSMS; ARTERY ANEURYSMS; DETACHABLE COILS; EARLY SURGERY; MANAGEMENT; TOMOGRAPHY; PATTERN; SERIES;
Keywords:
angiography, computed tomographic; decision analysis; diagnosis; perimesencephalic hemorrhage;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Ruigrok, YM Univ Utrecht, Med Ctr, Dept Neurol, POB 85500, NL-3500 GA Utrecht, Netherlands Univ Utrecht POB 85500 Utrecht Netherlands NL-3500 GA erlands
Citazione:
Y.M. Ruigrok et al., "Perimesencephalic hemorrhage and CT angiography - A decision analysis", STROKE, 31(12), 2000, pp. 2976-2983

Abstract

Background and Purpose-The method of choice for detecting or excluding a vertebrobasilar aneurysm still is a matter of debate in patients with a characteristically perimesencephalic pattern of subarachnoid hemorrhage (SAH) on CT. We used decision analysis to compare possible diagnostic strategies in these patients. Methods-A decision analytic model was developed to evaluate the effect of 4 different diagnostic strategies following a perimesencephalic pattern of SAH on CT: 1, no further investigation; 2, digital subtraction angiography (DSA) by catheter; 3, CT angiography as initial modality, not followed by DSA if negative; and 4, CT angiography as initial modality, followed by DSA. We used a 4% prevalence of a vertebrobasilar aneurysm given a perimesencephalic pattern of hemorrhage, a 97% sensitivity and specificity of CT angiography, and a 99.5% sensitivity and 100% specificity of DSA. In a prospectively collected series, the complication rate from DSA in patients with a perimesencephalic pattern of hemorrhage was 2.6%. We calculated the expected utility of each of the 4 diagnostic options and used sensitivity analyses toexamine the influence of the plausible ranges of the various estimates used. Results-The expected utilities were 99.09 for CT angiography only, 98.96 for no further investigation, 98.22 for DSA, and 96.34 for CT angiography plus DSA. The results of the sensitivity analysis indicate that over a wide range of assumptions, CT angiography only is the most beneficial option. Only when the complication rate of catheter angiography is <0.2% is DSA the preferred strategy. Conclusions-Our decision analysis shows that in patients with a perimesencephalic pattern of hemorrhage on CT, CT angiography only is the best diagnostic strategy. DSA can be omitted in patients with a perimesencephalic pattern of hemorrhage and a negative CT angiogram.

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Documento generato il 09/07/20 alle ore 00:49:59