title: Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: qualitative and quantitative analysis of 3D parameter maps.
abstract: OBJECTIVE
  Cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) implies high risk for secondary ischemia. It requires early diagnosis to start treatment on time. We aimed to assess the utility of "whole brain" VPCT for detecting localization and characteristics of arterial vasospasm.
  
  
  METHODS
  23 patients received a non-enhanced CT, VPCT and CTA of the brain. The distribution of ischemic lesions was analyzed on 3D-perfusion-parameter-maps of CBF, CBV, MTT, TTS, TTP, and TTD. CT-angiographic axial and coronal maximum-intensity-projections were reconstructed to determine arterial vasospasm. CT-data was compared to DSA, if performed additionally. Volume-of-interest placement was used to obtain quantitative mean VPCT values.
  
  
  RESULTS
  82% patients (n=19) had focal cerebral hypoperfusion. 100% sensitivity and 100% specificity was found for TTS (median 1.9s), MTT (median 5.9s) and TTD (median 7.6s). CBV showed no significant differences. In 78% (n=18) focal vessel aberrations could be detected either on CTA or DSA or on both.
  
  
  CONCLUSIONS
  VPCT is a non-invasive method with the ability to detect focal perfusion deficits almost in the whole brain. While DSA remains to be the gold standard for detection of CV, VPCT has the potential to improve noninvasive diagnosis and treatment decisions.
authors: Department of Neuroradiology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: karoline.dolatowski@gmail.com.
authors: K
authors: K
authors: Dolatowski
authors: Department of Neurosurgery, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: vesna.malinova@gmail.com.
authors: V
authors: V
authors: Malinova
authors: Department of Neuroradiology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: a.froelich@gmail.com.
authors: A M J
authors: AM
authors: Frölich
authors: Department of Neuroradiology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: ramona.schramm@med.uni-goettingen.de.
authors: R
authors: R
authors: Schramm
authors: Siemens AG, Healthcare Sector, Computed Tomography, H IM CR R&D PA SC, Siemensstr. 1, 91301 Forchheim, Germany. Electronic address: ulrike.haberland@siemens.com.
authors: U
authors: U
authors: Haberland
authors: Siemens AG, Healthcare Sector, Computed Tomography, H IM CR R&D PA SC, Siemensstr. 1, 91301 Forchheim, Germany. Electronic address: ernst.klotz@siemens.com.
authors: E
authors: E
authors: Klotz
authors: Department of Neurosurgery, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: dorothee.wachter@med.uni-goettingen.de.
authors: D
authors: D
authors: Mielke
authors: Department of Neuroradiology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Electronic address: michael.knauth@med.uni-goettingen.de.
authors: M
authors: M
authors: Knauth
authors: Department of Neuroradiology, UKSH University hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Electronic address: Peter.Schramm@uksh.de.
authors: P
authors: P
authors: Schramm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol
keywords: Brain imaging; CT perfusion; Cerebral vasospasm; Secondary ischemia; Subarachnoid hemorrhage