Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

@article{Dubosh2016SensitivityOE,
  title={Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis},
  author={Nicole M. Dubosh and M. Fernanda Bellolio and Alejandro A. Rabinstein and J.A. Edlow},
  journal={Stroke},
  year={2016},
  volume={47},
  pages={750–755}
}
Background and Purpose— Emerging evidence demonstrating the high sensitivity of early brain computed tomography (CT) brings into question the necessity of always performing lumbar puncture after a negative CT in the diagnosis of spontaneous subarachnoid hemorrhage (SAH). Our objective was to determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients. Methods— After… 
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The Ottawa SAH rule correctly identified all patients with SAH in this contemporary cohort and is a useful tool to aid in the decision for CT of the head in patients presenting with acute non-traumatic headache to the ED.

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CT undertaken within 6 hours (with expertise of a neuroradiologist or radiologist who routinely interprets brain images) is highly accurate and likely to be sufficient to rule out SAH; CT beyond 6 hours is much less sensitive.

Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double inversion recovery

The DIR sequence was more reliable at identifying signal abnormalities in subacute SAH patients than the T2*-W and SWI sequence, and is suggested as a promising imaging technique for detecting hemorrhagic areas without considering the anatomical distribution of SAH.

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The role of imaging in the management of non-traumatic subarachnoid hemorrhage: a practical review

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...

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