• Kazufumi Suzuki, Aoi Kurashima, Kayoko Abe, Tatsuya Ishikawa, Koji Yamaguchi, Takakazu Kawamata, Arino Yaguchi, and Shuji Sakai.
• Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: kasuzuki-rad@umin.ac.jp.
• World Neurosurg. 2020 Feb 1; 134: e237-e242.

BackgroundContrast-enhanced computed tomography angiography (CTA) can be used to detect contrast extravasation in intracerebral hemorrhage. However, investigation for contrast extravasation in subarachnoid hemorrhage (SAH) is insufficient. We evaluated the efficacy of dual-phase CTA to improve evaluation of contrast extravasation in SAH.MethodsWe retrospectively evaluated 35 patients with SAH who underwent contrast-enhanced dual-phase CTA within 24 hours from onset. The second-phase scan was performed 8 or 15 seconds following the usual CTA. The frequency of contrast extravasation was compared between phases. We also recorded the time from onset, coma level, interventional treatment, and early mortality.ResultsOf 35 patients (22.9%) with SAH, 8 showed contrast extravasation in the second phase compared with 3 in the first phase. Contrast extravasation was correlated with clinical coma level (P < 0.05), and all contrast extravasation was found within 6 hours from onset. Early mortality, treatment decision, and hematoma distribution type did not correlate with existence of contrast extravasation. We also observed 4 cases of secondary subpial hematoma due to SAH, with 3 showing extravasation in both phases.ConclusionsDual-phase CTA with a short interval enhances detection frequency of contrast extravasation in SAH and might be a better evaluation tool for SAH.Copyright © 2019 Elsevier Inc. All rights reserved.

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