title: Non-invasive quantitative monitoring of cerebral blood flow in aneurysmal subarachnoid haemorrhage with 99mTc-ECD.
abstract: The purpose of this prospective study was to detect symptomatic cerebral vasospasm in aneurysmal subarachnoid haemorrhage (SAH) by a non-invasive mean cerebral blood flow (mCBF) quantification using 99mTc-ethyl cysteinate dimer. Measurement of mCBF without blood sampling and single photon emission tomography (SPECT) were performed at 1 and 7 days after surgery in 35 consecutive SAH patients, of whom 16 were examined at day 30 as well. A decrease in mCBF of more than 10% on day 7 versus day 1 was considered to indicate vasospasm. On visual interpretation of SPECT, a perfusion decrease which appeared newly on day 7 was considered to indicate vasospasm. In total, nine of 35 patients had cerebral vasospasm confirmed by computed tomography (CT) and/or angiography. The mCBF measurement showed a 77.8% (7/9) sensitivity, a 88.5% (23/26) specificity, a 70.0% (7/10) positive predictive value, and a 92.0% (23/25) negative predictive value. SPECT yielded a 33.3% (3/9) sensitivity, a 73.1% (19/26) specificity, a 30.0% (3/10) positive predictive value, and a 76.0% (19/25) negative predictive value. On SPECT, decreased perfusion was observed in most of the patients at clipping sites, which might represent post-operative transient abnormal perfusion and should not be read as vasospasm. In conclusion, this mCBF measurement is more accurate than visual interpretation of SPECT for detecting vasospasm.
authors.affiliation: Department of Radiology, Saitama Medical Center, Saitama Medical School, Kawagoe, Japan. makohoso@saitama-med.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Hosono
authors.forename: K
authors.initials: K
authors.lastname: Machida
authors.forename: T
authors.initials: T
authors.lastname: Matsui
authors.forename: N
authors.initials: N
authors.lastname: Honda
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Dei
authors.forename: A
authors.initials: A
authors.lastname: Kashimada
authors.forename: Y
authors.initials: Y
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Osada
authors.forename: M
authors.initials: M
authors.lastname: Ohmichi
authors.forename: T
authors.initials: T
authors.lastname: Asano
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003545:Cysteine / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine