ArticleAJNR. American journal of neuroradiology2017
Effects of Radiation Exposure on the Cost-Effectiveness of CT Angiography and Perfusion Imaging in Aneurysmal Subarachnoid Hemorrhage.
Article in AJNR. American journal of neuroradiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis.Neuroradiology · 2017Pooled it
- Maximizing Neurovascular Outcomes of Facial Transplantation: A Comprehensive Review.Clinical anatomy (New York, N.Y.) · 2026Review
- The Effects of Milrinone Systemic Administration on Cerebral Perfusion as Measured with Computed Tomography in Aneurysmal Subarachnoid Hemorrhage Patients.Neurocritical care · 2026Observational
- Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention.Neurocritical care · 2023Review
- Multidisciplinary and standardized management of patients with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Acta neurochirurgica · 2022Article
- Cost-Effectiveness Study of Initial Imaging Selection in Acute Ischemic Stroke Care.Journal of the American College of Radiology : JACR · 2021Article
- Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care.Frontiers in neurology · 2021Article
- Delayed Ischemic Neurologic Deficit after Aneurysmal Subarachnoid Hemorrhage.Asian journal of neurosurgeryReview
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeCT angiography and perfusion imaging is an important prognostic tool in the management of patients with aneurysmal subarachnoid hemorrhage. The purpose of this study was to perform a cost-effectiveness analysis of advanced imaging in patients with SAH, incorporating the risks of radiation exposure from CT angiography and CT perfusion imaging. MATERIALS AND
methodsThe risks of radiation-induced brain cancer and cataracts were incorporated into our established decision model comparing the cost-effectiveness of CT angiography and CT perfusion imaging and transcranial Doppler sonography in SAH. Cancer risk was calculated by using National Cancer Institute methodology. The remaining input probabilities were based on literature data and a cohort at our institution. Outcomes were expected quality-adjusted life years gained, costs, and incremental cost-effectiveness ratios. One-way, 2-way, and probabilistic sensitivity analyses were performed.
resultsCT angiography and CT perfusion imaging were the dominant strategies, resulting in both better health outcomes and lower costs, even when incorporating brain cancer and cataract risks. Our results remained robust in 2-way sensitivity analyses varying the prolonged latency period up to 30 years, with either brain cancer risk up to 50 times higher than the upper 95% CI limit or the probability of cataracts from 0 to 1. Results were consistent for scenarios that considered either symptomatic or asymptomatic patients with SAH. Probabilistic sensitivity analysis confirmed our findings over a broad range of selected input parameters.
conclusionsWhile risks of radiation exposure represent an important consideration, CT angiography and CT perfusion imaging remained the preferred imaging compared with transcranial Doppler sonography in both asymptomatic and symptomatic patients with SAH, with improved health outcomes and lower health care costs, even when modeling a significantly higher risk and shorter latency period for both cataract and brain cancer than that currently known.
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