Although CTA and MRI/MRA have a high sensitivity and specificity compared with catheter arteriography (see below), they may miss important lesions. In one series of 89 patients with IPH not in the typical hypertensive locations who had negative CTA and MRI/MRA, catheter arteriography identified 7 arteriovenous malformations and 3 dural arteriovenous fistulas [89]. In the acute period, catheter arteriography may miss vascular lesions that are detected by repeat arteriography several weeks later [90]. In addition, catheter arteriography is usually performed in patients with pure intraventricular hemorrhage, due to the high prevalence of vascular lesions [88]. Cerebrovascular Diseases-Stroke CT Head With IV Contrast Contrast-enhanced CT is typically not helpful in the setting of typical hypertensive hemorrhage or in serial follow- up, except in cases in which underlying metastatic disease is suspected and MRI is not feasible for a specific patient. CT Head Without and With IV Contrast Contrast-enhanced CT is typically not helpful in the setting of typical hypertensive hemorrhage or in serial follow- up, except in cases in which underlying metastatic disease is suspected and MRI is not feasible for a specific patient. CT Head Without IV Contrast In the setting of IPH, noncontrast CT examinations of the head is essential, both for the initial diagnosis and, if clinically indicated, for follow-up examinations to evaluate for expansion and worsening mass effect. Additional noncontrast CT imaging may not be warranted when the patient is stable. CTA Neck With IV Contrast In the setting of IPH, CTA of the neck is not supported by the literature. CTA of the neck may be useful for treatment planning when endovascular management is expected. CTV Head With IV Contrast In the setting of typical hypertensive hemorrhage, there is no relevant literature to support CTV of the head. However, CTV of the head may be useful to exclude CVT as a potential etiology.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. Although CTA and MRI/MRA have a high sensitivity and specificity compared with catheter arteriography (see below), they may miss important lesions. In one series of 89 patients with IPH not in the typical hypertensive locations who had negative CTA and MRI/MRA, catheter arteriography identified 7 arteriovenous malformations and 3 dural arteriovenous fistulas [89]. In the acute period, catheter arteriography may miss vascular lesions that are detected by repeat arteriography several weeks later [90]. In addition, catheter arteriography is usually performed in patients with pure intraventricular hemorrhage, due to the high prevalence of vascular lesions [88]. Cerebrovascular Diseases-Stroke CT Head With IV Contrast Contrast-enhanced CT is typically not helpful in the setting of typical hypertensive hemorrhage or in serial follow- up, except in cases in which underlying metastatic disease is suspected and MRI is not feasible for a specific patient. CT Head Without and With IV Contrast Contrast-enhanced CT is typically not helpful in the setting of typical hypertensive hemorrhage or in serial follow- up, except in cases in which underlying metastatic disease is suspected and MRI is not feasible for a specific patient. CT Head Without IV Contrast In the setting of IPH, noncontrast CT examinations of the head is essential, both for the initial diagnosis and, if clinically indicated, for follow-up examinations to evaluate for expansion and worsening mass effect. Additional noncontrast CT imaging may not be warranted when the patient is stable. CTA Neck With IV Contrast In the setting of IPH, CTA of the neck is not supported by the literature. CTA of the neck may be useful for treatment planning when endovascular management is expected. CTV Head With IV Contrast In the setting of typical hypertensive hemorrhage, there is no relevant literature to support CTV of the head. However, CTV of the head may be useful to exclude CVT as a potential etiology.