title: Perfusion-CT assessment of blood-brain barrier permeability in patients with aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  The goal of this study was to determine which clinical and radiographic variables in patients with subarachnoid hemorrhage (SAH) are associated with in vivo blood-brain barrier permeability (BBBP) assessments obtained using perfusion-CT (PCT) technology.
  
  
  METHODS
  SAH patients with confirmed aneurysm etiology and with PCT and angiogram within 24 hours of each other were included, and relationships between clinical and imaging variables were analyzed using random-effects generalized linear models.
  
  
  RESULTS
  One thousand one hundred and sixty two vascular territories from 83 patients were evaluated in this study. The mean BBBP increased by severity of vasospasm on DSA, however, in multivariate analysis, only mean transit time (MTT), cerebral blood volume (CBV), and severity of hydrocephalus were significantly associated with BBBP. Increased BBBP was not associated with angiographic vasospasm severity in multivariate analysis.
  
  
  CONCLUSIONS
  Perfusion-CT assessment of BBBP may serve as a unique and useful biomarker in conjunction with angiography, additional perfusion-CT parameters, and clinical assessments, especially in characterizing microvascular dysfunction, or even in targeting treatments. However, future prospective studies will be required to definitively establish its clinical utility in the care of SAH patients.
authors.affiliation: University of California, Department of Radiology, Neuroradiology Section, San Francisco, California, United States.
authors.forename: Sirish
authors.initials: S
authors.lastname: Kishore
authors.forename: Nerissa
authors.initials: N
authors.lastname: Ko
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Soares
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tong
authors.forename: Sumail
authors.initials: S
authors.lastname: Bhogal
authors.forename: Joerg
authors.initials: J
authors.lastname: Bredno
authors.forename: Su-Chun
authors.initials: SC
authors.lastname: Cheng
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging* / Q000378:metabolism*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007455:Iodine / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D010539:Permeability; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000378:metabolism*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D007455:Iodine