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Rebleeding of Aneurysmal Subarachnoid Hemorrhage in Computed Tomography Angiography: Risk Factor, Rebleeding Pattern, and Outcome Analysis

Wu, Te-Chang MD*; Tsui, Yu-Kun MD*; Chen, Tai-Yuan MD*; Lin, Chien-Jen MD*; Wu, Tai-Ching MD*; Tzeng, Wen-Sheng MD*†‡

Journal of Computer Assisted Tomography: January/February 2012 - Volume 36 - Issue 1 - p 103–108
doi: 10.1097/RCT.0b013e31823f2e57

Objective For patients with subarachnoid hemorrhage (SAH), computed tomography angiography (CTA) has been the first imaging modality for aneurysm detection. We evaluate the rate, time distribution, risk factors, and clinical outcome of aneurysmal rebleeding by CTA findings.

Methods Consecutive patients with SAH presenting to our hospital, a tertiary care hospital, were retrospectively included. We reviewed images for all patients receiving an initial noncontrast computed tomography scan and further CTA for nontraumatic SAH surveillance with focus on rebleeding evidence.

Results A total of 12 patients with early aneurysmal rebleeding (12/110 patients [10.9%]) within 6 hours after emergency room arrival were found with dismal outcome (50% mortality) and 3 rebleeding patterns: pattern 1 of rapid active bleeding with contrast extravasation, pattern 2 of slow active bleeding with contrast leakage in the delayed venous phase, and pattern 3 of hematoma enlargement. The risk factor and poor prognostic sign include larger aneurysm diameter (≧7 mm) and contrast extravasation during CTA.

Conclusions Rebleeding rate of aneurysmal SAH in the hyperacute stage at less than 6 hours is 10.9% with poor prognosis in this study, especially in patients with active bleeding demonstrated in CTA.

From the *Department of Radiology, Chi-Mei Medical Center, Tainan;†Department of Radiological Technology, Central Taiwan University of Science and Technology College of Health Sciences, Taichung; and ‡Department of Medical Science, National Defense Medical Center, Taipei, Taiwan.

Received for publication June 21, 2011; accepted October 27, 2011.

Reprints: Te-Chang Wu, MD, Department of Radiology, Chi-Mei Medical Center, No. 901, Chung Hwa Rd, Yung Kang District, Tainan, Taiwan (e-mail:

The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.