CT perfusion predicts secondary cerebral infarction after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage (SAH).


METHODS
During 2 weeks after SAH, 38 consecutive patients completed an average of 3.5 CT/CTP and 10.7 TCD examinations at regular intervals as required by the study protocol. SCI was defined as delayed infarction on native CT between 3 and 14 days after SAH and developed in n = 14 patients (n = 24 without SCI). Analysis was based on examination dates before SCI. Common measures of diagnostic accuracy were calculated for qualitative CTP (visual color-map ratings from two blinded observers) and TCD assessments (mean flow velocity >120 cm/s in anterior, middle, and posterior cerebral artery territories). Quantitative measures, which for CTP were obtained from cortical a priori regions of interest corresponding to the vascular territories, were analyzed by binary logistic regression.


RESULTS
Time of prediction for SCI by CTP was at a median of 3 days (range 2 to 5 days) before manifestation of complete infarction on native CT. Visual assessment of time-to-peak (TTP) color maps performed best for the prediction of SCI with 0.93 sensitivity (95% CI: 0.7 to 1.0) and 0.67 specificity (95% CI: 0.53 to 0.7). On quantitative analysis, the odds ratio (OR) for 1 second of side-to-side delay in TTP was 1.4 (p = 0.01, Wald chi(2) = 8.57, CI: 1.07 to 1.82). Daily TCD measures were not significantly related to SCI at any time before complete infarction on native CT.


CONCLUSIONS
Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.
Pham
M
M
Department of Neuroradiology, University of Würzburg, Würzburg, Germany. pham@neuroradiologie.uni-wuerzburg.de
Johnson
A
A
Bartsch
A J
AJ
Lindner
C
C
Müllges
W
W
Roosen
K
K
Solymosi
L
L
Bendszus
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods