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ARTICLES: J. N. Goldstein, L. E. Fazen, R. Snider, K. Schwab, S. M. Greenberg, E. E. Smith, M. H. Lev, and J. Rosand Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage Neurology 2007; 68: 889-894 [Abstract] [Full text] [PDF]

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Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage

Yasuo Murai, Yukio Ikeda and Akira Teramoto   (23 May 2007)

Reply from the authors

Joshua N. Goldstein, Steven M. Greenberg, Eric E. Smith, Michael H. Lev, and Jonathan Rosand   (23 May 2007)

Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage 23 May 2007
Yasuo Murai, Department of Neurosurgery, Nippon Medical School 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan, Yukio Ikeda and Akira Teramoto Send Correspondence to journal: Re: Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage ymurai{at}nms.ac.jp Yasuo Murai, et al.	We read the article by Goldstein et al with great interest. [1] The authors have attempted to prove the hypothesis that contrast extravasation on CT angiography (CTA) at presentation can predict subsequent hematoma expansion in patients with hyperacute stage intracerebral hemorrhage (ICH). We have published reports on patients with ICH in whom evidence of extravasation on three dimensional CT angiography and contrast enhanced magnetic resonance imaging was demonstrated. [2,3] One major task in patient management with hyperacutestage ICH is to determine whether a hemorrhage is secondary to an underlying vascular abnormality. In our report, we also described that 3DCTA is essential for the detection of vascular abnormalities as a cause of bleeding. Vascular abnormalities including cerebral aneurysm or moyamoya disease were revealed with the aid of 3DCTA in 31 patients. [3] The study by Goldstein et al does not provide sufficient evidence that 3DCTA can be used as a modality to detect the source of hemorrhage in patients with hyperacute stage ICH. [1] We would like the authors to comment on whether 3DCTA is also effective for diagnosing the cause of hemorrhage. References 1. Goldstein JN, Fazen LE, Snider R, Schwab et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology 2007; 68:889-894. 2. Murai Y, Ikeda Y, Teramoto A, Tsuji Y. Magnetic resonance imaging- documented extravasation as an indicator of acute hypertensive intracerebral hemorrhage. J Neurosurg 1998;88:650-655. 3. Murai Y, Takagi R, Ikeda Y, Yamamoto Y, Teramoto A. Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage. J Neurosurg 1999;91:424-431. Disclosure: The authors report no conflicts of interest.
Reply from the authors 23 May 2007
Joshua N. Goldstein, Massachusetts General Hospital Department of Emergency Medicine, 55 Fruit Street, Clinics 115, Boston, MA 02114, Steven M. Greenberg, Eric E. Smith, Michael H. Lev, and Jonathan Rosand Send Correspondence to journal: Re: Reply from the authors jgoldstein{at}partners.org Joshua N. Goldstein, et al.	We thank Murai et al for their comments. We are familiar with their work and their findings helped motivate our study. As in their institution, we typically use CT angiography to evaluate for secondary causes of intracerebral hemorrhage [4]. However, this particular analysis focused exclusively on primary intracerebral hemorrhage, and excluded all patients in whom any secondary source was found (including vascular malformation, aneurysm, tumor, or moyamoya disease). Therefore, the yield of CTA for such findings was a topic beyond the scope of our investigation. References 4. Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004; 54: 1329-1342. Disclosure: The authors report no conflicts of interest.