Convenience of the computed tomography perfusion method for cerebral vasospasm detection after subarachnoid hemorrhage.
BACKGROUND
Vasospasm is a frequent complication in the early clinical course after SAH. Although various methods have been used to measure cerebral perfusion including PET, SPECT, xenon CT, and TCD, these require the patients to remain still for a long period. In addition, TCD is operator dependent. The current study aimed to clarify the convenience of CTP for the assessment of cerebral vasospasm caused by SAH.


METHODS
Nineteen patients with SAH aged 44 to 85 years (mean, 64 years) were recruited with informed consent. All patients were treated with the prevailing therapy and underwent CTP on days 6 to 9, followed by DSA and 3D-CTA to detect cerebral vasospasm. In each patient, we measured the MTT, CBF, and CBV. The reliability of CTP data was verified by comparing the data from CTP and xenon CT between the controls, and the average was calculated. Six ROIs were located symmetrically in the frontal, temporal, and occipital lobes.


RESULTS
An MTT value more than 20% greater than the average indicated the progression of cerebral vasospasm, and patients with vasospasm-related infarcts exhibited an MTT more than 47% greater than the mean value (odds ratio, 50). Patients with delayed cerebral infarcts had a significantly lower mean CBF and CBV and higher MTT than patients who did not develop CI.


CONCLUSIONS
Significant correlations between MTT and CBF values and neurovascular findings were obtained. Computed tomography perfusion can be performed in a short time and on a regular basis, and it therefore has the potential to identify cerebral vasospasm because of SAH.
Kanazawa
Ryuzaburo
R
Department of Neurosurgery, Kameda Medical Center, Kamogawa, Japan. ryu@nms.ac.jp <ryu@nms.ac.jp>
Kato
Mitsuhisa
M
Ishikawa
Kazuya
K
Eguchi
Tsuneyoshi
T
Teramoto
Akira
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007455:Iodine; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D015203:Reproducibility of Results; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D014980:Xenon Radioisotopes
D003287:Contrast Media; D014980:Xenon Radioisotopes; D007455:Iodine