title: Evaluating CT Perfusion Deficits in Global Cerebral Edema after Aneurysmal Subarachnoid Hemorrhage.
abstract: OBJECTIVE
  Global cerebral edema is an independent predictor of mortality and poor outcomes after aneurysmal SAH. Global cerebral edema, a complex disease process, is thought to be associated with an altered cerebral autoregulatory response. We studied the association between cerebral hemodynamics and early global cerebral edema by using CTP.
  
  
  METHODS
  We retrospectively studied consecutive patients with aneurysmal SAH with admission CTP performed at days 0-3. Two neuroradiologists classified global cerebral edema and hydrocephalus on NCCT performed concurrently with CTP. Global cerebral edema was defined as diffuse effacement of the sulci and/or basal cisterns or diffuse disruption of the cerebral gray-white matter junction. CTP was postprocessed into CBF and MTT maps by using a standardized method. Quantitative analysis of CTP was performed by using standard protocol with ROI sampling of the cerebral cortex. The Fisher exact test, Mann-Whitney test, and independent-samples t test were used to determine statistical associations.
  
  
  RESULTS
  Of the 45 patients included, 42% (19/45) had global cerebral edema and 58% (26/45) did not. Patient groups with and without global cerebral edema were well-matched for demographic and clinical data. Patients with global cerebral edema were more likely to have qualitative global CTP deficits than those without global cerebral edema (P = .001) with an OR = 13.3 (95% CI, 2.09-138.63). Patients with global cerebral edema also had a very strong trend toward statistical significance, with reduced quantitative CBF compared with patients without global cerebral edema (P = .064).
  
  
  CONCLUSIONS
  Global perfusion deficits are significantly associated with global cerebral edema in the early phase after aneurysmal SAH, supporting the theory that hemodynamic disturbances occur in global cerebral edema.
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.) heb2017@nyp.org.
authors.forename: H
authors.initials: H
authors.lastname: Baradaran
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.).
authors.forename: V
authors.initials: V
authors.lastname: Fodera
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.).
authors.forename: D
authors.initials: D
authors.lastname: Mir
authors.forename: K
authors.initials: K
authors.lastname: Kesavabhotla
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.).
authors.forename: K
authors.initials: K
authors.lastname: Kesavobhotla
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.).
authors.forename: J
authors.initials: J
authors.lastname: Ivanidze
authors.affiliation: Public Health (U.O.), NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: U
authors.initials: U
authors.lastname: Ozbek
authors.affiliation: From the Departments of Radiology (H.B., V.F., D.M., K.K., J.I., A.G.).
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Neurology (J.C.), NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: J
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Department of Radiology (P.C.S.), North-Shore-Long Island Jewish Health System, Great Neck, New York.
authors.forename: P C
authors.initials: PC
authors.lastname: Sanelli
mesh_terms: D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*