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The perfo1mance, operation, efficiency, images, results including its appearance and software usage of the PET-CT Scanner model: Nuesight PET/CT 64 with SIN: PT installed and supplied at the University of Perpetual Help DALTA Medical Center, Alabang-Zapote Rd. Pamplona Tres, Las Pinas Philippines is found to be excellent and working satisfactory since installation from and our continuous support from Neusoft Medical Systems Co., Ltd. is sufficient and highly adequate.

Patient selection

The ethics committee of Mashhad university of medical sciences approved the study (approval code: IR.MUMS.MEDICAL.REC..097) and waived the need for informed consent.

We searched our Picture Archiving and Communicating System (PACS) of our tertiary-level academic hospital between and for four years and collected all consecutive patients hospitalized for intra-parenchymal brain hemorrhage. Inclusion criteria were patients with acute neurologic symptoms who were diagnosed with ICH in the non-contrast brain CT scan (NCCT) at presentation, age above eighteen years, and available brain CTA obtained within 48 h from primary NCCT. The exclusion criteria were history of head trauma within the previous two weeks, evidence of ischemic stroke on the site of hemorrhage, evidence of aneurysmal hemorrhage in the CTA, history of known vascular malformation or vascular mass within the brain, known amyloid angiopathy according to Boston&#;s criteria, and the presence of severe artifacts in NCCT or CTA making the interpretation challenging and incomplete imaging protocol. A total of 334 patients were enrolled in this study.

Imaging

All MDCTA and NCCT examinations were performed with a commercially available 16-MDCT scanner (Neusoft, Neuviz 16). NCCT was performed in a head holder by an axial technique with 120 kilovolts (peak), 150 mA, and 5-mm thickness reconstruction. MDCTA was performed by scanning from the base of the C1 body to the vertex using the following parameters: pitch (1.2); collimation, 1.25 mm; maximal mA, 250; kilovolt (peak), 120; FOV, 22 cm; and 100 mL of iodinated contrast material (Iodixanol 320 mg/100 mL) with the flow rate of 4 mL/s, followed by 50 mL of saline chaser injected with the same flow rate into the antecubital vein with a 25-s delay between starting the contrast injection and the start of scanning.

Image interpretation

Two radiologists, including an interventional radiologist with 10 years of experience in vascular imaging, and a general radiologist with 4 years of experience in general radiology, assessed the non-contrast CT scans and MDCTA images. In cases of discrepancy, a third opinion was sought from another radiologist with 5 years of experience. Image interpretation was performed on a standard PACS workstation. They were asked to record the location of ICH (lobar, deep grey matter or pons, and infratentorial), the presence of intraventricular hemorrhage (IVH), or subarachnoid hemorrhage (SAH) and the presence of considerable perilesional edema in NCCTs.

They also evaluated the probability of underlying vascular lesions into three categories of high probable, indeterminate, and low probable according to the following criteria used in the previous literature 10:

High probable: The presence of enlarged vessels, with associated calcifications around the lesion or increased dural vein attenuation. (Fig. 1).

Axial non contrast CT scan (a) shows left basal ganglia hemorrhage and a round calcified lesion near it. The findings are high probable of underlying vascular lesion and showed to be an Arteriovenous malformation (AVM) in brain CTA (b).

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Low probable: ICH in the pons or deep grey matter, without associated high-probable criteria. (Fig. 2).

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39-year-old man with history of hypertension. Axial non contrast CT scan shows right basal ganglia hemorrhage with surrounding edema. These findings are low probable of underlying vascular lesions and no vascular etiology was found on brain CTA.

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Indeterminate: the lesions which do not fall in either of the above criteria.

CTA images were then interpreted by the same radiologists. The CTA images were evaluated at least two weeks after the NCCT image to prevent recall bias. The final CTA outcome was recorded as positive/negative according to the presence of vascular lesions (AVM, dural AVF, dural vein thrombosis, etc.) in the CTA images.

Other diagnostic data including MRA/MRV results, surgical and pathological reports, and digital subtraction angiography (DSA), etc. were also recorded. If other diagnostic methods revealed a vascular lesion not detected by CTA, the final analysis included the results.

Furthermore, we used the independent predictors of a positive CTA (NCCT probability, age, hypertension, impaired coagulation, IVH or SAH, location of ICH, associated edema), to construct a practical scoring system to predict the risk of vascular etiology in ICH patients, so called the Vascular ICH score (VICH score).

Medical record review

Medical records were reviewed for patient age, sex, presence of known hypertension, and presence of coagulopathy. We divided our patients according to their age into one of the following two categories: group 1, 18&#;45 years of age; and group 2, patients 46 years of age and older.

Patients were also classified as hypertensive if they had a history of hypertension on medical records or were taking antihypertensive medications at presentation. Patients were classified as having coagulopathy if, at presentation, they were receiving daily anti-platelet therapy with aspirin (at least 81 mg) and/or clopidogrel had a platelet count of&#;<&#;50,000 cells per cubic millimeter of blood, were on anticoagulation with warfarin and had an international normalization ratio (INR)&#;>&#;1.5, or were on anticoagulation with heparin and had an active partial thromboplastin time (aPTT) of&#;>&#;80 s.

Statistical analysis

All the obtained data were collected on a database. Demographic, historical and clinical characteristics are summarized using descriptive statistics. A comparison between the groups.was made by conducting T tests. Categorical variables were compared using the χ2 test. Multivariable logistic regression models were conducted to investigate the association between the VICH scores and positive CTAs. Data were analyzed using IBM SPSS version 26. A p-value of less than 0.05 was considered statistically significant.

Ethical considerations

The ethics committee of Mashhad university of medical sciences approved the study (approval code: IR.MUMS.MEDICAL.REC..097) and waived the need for informed consent.

Patients' personal information, including names, was removed from the images and was replaced with a code unique to every individual. Patients&#; medical and personal information were not shared outside the research group.

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