Identify Source of Hemorrhage
Once bleeding has been identified, locating the source of the bleeding is necessary to decide on future treatment. A hemorrhagic stroke can be caused by spontaneous bleeding due to high blood pressure or by defective blood vessels in the brain, e.g. a ruptured aneurysm or ruptured AVM. Neuro-imaging techniques help differentiating between these two causes of hemorrhage. In the case of aneurysm, imaging techniques help locating the vessels, evaluating the aneurysm’s neck geometry and determining the size of the disruption. This also helps you planning the treatment, as depending on the location, size and width of the ruptured vessels an interventional or surgical treatment will be indicated. In the case of an arteriovenous malformation, the localization of the vessel and the inflow and outflow to the vessel will determine the type of intervention. Siemens supports you with angiography, CT and MR angiography protocols for effective decision-making in regards to treatment possibilities.
Intra-arterial angiography combines excellent diagnostic output with the ability to immediate therapeutic intervention in a single procedure. It is the diagnostic and therapeutic tool of choice if the need for vascular intervention is indicated.
Digital Subtraction Angiography (DSA) is the gold standard¹ for evaluating intracranial and extracranial vessels (carotid arteries, vertebral arteries). If an anomaly like AVM or aneurysm is diagnosed, the interventional radiologist may perform embolization of the pathology.
CTA is a rapid and non-invasive alternative to catheter based angiography for larger aneurysm and AVM. CT angiography (CTA) provides high-resolution images of intra- and extra-cranial, as well as cervical blood vessels. Together with the ability to localize and evaluate hemorrhagic brain areas, CTA allows for a quick and reliable identification of ruptured aneurysms. CTA enables a profound evaluation of brain circulation and differential analysis of vascular lesions.
Siemens assists you with latest CT scanner technology, imaging and analysis software, and highly efficient workflows to provide fast and evidence-based care to your stroke patients.
State-of-the-art MR scanners allow for plain (non-contrast) or contrast-enhanced visualization of intra- and extra-cranial blood vessels, thus representing a non-invasive alternative to catheter based angiography. Smaller bleedings with slow flow, such as caused by cavernomas, might even be better visualized on susceptibility weighted imaging (SWI) than on conventional angiography. Siemens MAGNETOM MR scanners, imaging software, and streamlined workflows help you provide fast evidence-based diagnosis and immediate brain-saving therapy for your stroke patients even without the application of contrast agents.
Source: Stroke - A Journal of Cerebral Circulation, How accurate is CT angiography in evaluating intracranial atherosclerotic disease? 2008 Apr; 39(4): 1184-8, and Journal of NeuroInterventional Surgery, Neuroimaging. 2012 May; 4(3): 219-25.