Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage.
OBJECTIVE
Computed tomography perfusion (CTP) has gained significant relevance for the radiological screening of patients at risk of developing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Particularly, the impact of MTTPEAK, i.e., the maximal mean transit time value in a series of CTP measurements, for the prediction of long-term outcome has recently been demonstrated by our group. Complementing this recent work, the present study investigated how the timing of MTTPEAKaffected the long-term outcome after aneurysmal subarachnoid hemorrhage.


METHODS
CTP examinations from 103 patients with clinical deterioration attributed to DCI after aSAH were retrospectively analyzed for time interval between SAH ictus and onset of MTTPEAKin association with modified Rankin Scale (mRS) 23.1 months after SAH.


RESULTS
Patients with unfavorable outcome (mRS > = 2) suffered significant earlier MTTPEAKonsets than patients with favorable outcome (mRS = 0 and 1). MTTPEAKwithin the first week was associated with significantly higher mRS scores compared to later MTTPEAK. Timing of MTTPEAKtogether with the value of MTTPEAKand initial World Federation of Neurosurgical Societies (WFNS) grade was a significant predictor for an unfavorable outcome (mRS > = 2).


CONCLUSIONS
The current findings suggest a presumably higher vulnerability of the brain to early microcirculatory impairments after aSAH and highlight that timing of MTT elevations could be considered for the identification of patients at increased risk for poor neurological outcome due to DCI.
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.|Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, 52425, Jülich, Germany.
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Caspers
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany. Christian.Rubbert@med.uni-duesseldorf.de.
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Rubbert
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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Turowski
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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Martens
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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Reichelt
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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May
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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Aissa
Department of Neurosurgery, Medical Faculty, Heinrich-Heine University, 40225, Dusseldorf, Germany.
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Hänggi
Department of Neurosurgery, Medical Faculty, Heinrich-Heine University, 40225, Dusseldorf, Germany.
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Etminan
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Dusseldorf, Germany.
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Mathys
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D015984:Causality; D002533:Cerebral Angiography / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D000072226:Computed Tomography Angiography / Q000379:methods* / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D063177:Pulse Wave Analysis / Q000379:methods* / Q000706:statistics & numerical data; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology
Delayed cerebral ischemia; Mean transit time; Outcome; Perfusion computed tomography; Subarachnoid hemorrhage; Vasospasm