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Neurology India, Vol. 53, No. 1, January-March, 2005, pp. 77-78 Invited Comments Invited Comments Tomandl BerndF Department of Diagnostic and Interventional Radiology, Nuremberg Related article: Cerebral computed tomographic angiography scan delay in subarachnoid hemorrhage Code Number: ni05021 CT-Angiography is increasingly accepted as the primary tool to search for intracranial aneurysms in patients with SAH. To ensure optimal enhancement of intracranial arteries efficient bolus timing is crucial. Currently there are three possibilities for bolus timing: Using a fixed delay-time (e.g. 20 sec) will usually lead to good results but in some patients opacification of arteries will not be optimal. The test-bolus method and bolus-tracking techniques both allow for ideal bolus timing and are therefore accepted as the preferred methods when optimized vessel opacification is required. For those who insist on using a fixed delay-time the study of Lukosevicius et al gives important information. The study shows that the ideal delay-time not only depends on the age of a patient with SAH but also on the clinical stage as measured by means of the Hunt-Hess classification. This finding may be explained by the well-known fact that the intracranial pressure increases in a poor clinical stage. Thus in older patients with a Hunt-Hess grade >2 a fixed delay of 20 sec will most likely not lead to sufficient opacification of arteries in most cases. The paper nicely shows that bolus timing should always be individualized especially in patients with SAH and a fixed delay cannot be recommended. Copyright 2005 - Neurology India |
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