title: Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage.
abstract: OBJECT This prospective study investigated the role of whole-brain CT perfusion (CTP) studies in the identification of patients at risk for delayed ischemic neurological deficits (DIND) and of tissue at risk for delayed cerebral infarction (DCI). METHODS Forty-three patients with aneurysmal subarachnoid hemorrhage (aSAH) were included in this study. A CTP study was routinely performed in the early phase (Day 3). The CTP study was repeated in cases of transcranial Doppler sonography (TCD)-measured blood flow velocity (BFV) increase of > 50 cm/sec within 24 hours and/or on Day 7 in patients who were intubated/sedated. RESULTS Early CTP studies revealed perfusion deficits in 14 patients, of whom 10 patients (72%) developed DIND, and 6 of these 10 patients (60%) had DCI. Three of the 14 patients (21%) with early perfusion deficits developed DCI without having had DIND, and the remaining patient (7%) had neither DIND nor DCI. There was a statistically significant correlation between early perfusion deficits and occurrence of DIND and DCI (p < 0.0001). A repeated CTP was performed in 8 patients with a TCD-measured BFV increase > 50 cm/sec within 24 hours, revealing a perfusion deficit in 3 of them (38%). Two of the 3 patients (67%) developed DCI without preceding DIND and 1 patient (33%) had DIND without DCI. In 4 of the 7 patients (57%) who were sedated and/or comatose, additional CTP studies on Day 7 showed perfusion deficits. All 4 patients developed DCI. CONCLUSIONS Whole-brain CTP on Day 3 after aSAH allows early and reliable identification of patients at risk for DIND and tissue at risk for DCI. Additional CTP investigations, guided by TCD-measured BFV increase or persisting coma, do not contribute to information gain.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Vesna
authors.initials: V
authors.lastname: Malinova
authors.affiliation: Neuroradiology, and.
authors.forename: Karoline
authors.initials: K
authors.lastname: Dolatowski
authors.affiliation: Neuroradiology, and.|Department of Neuroradiology, University of Lübeck, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schramm
authors.affiliation: Anaesthesiology, Georg-August-University, Göttingen; and.
authors.forename: Onnen
authors.initials: O
authors.lastname: Moerer
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Mielke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: BFV = blood flow velocity; CBF = cerebral blood flow; CBV = cerebral blood volume; CT perfusion; CTA = CT angiography; CTP = CT perfusion; DCI = delayed cerebral infarction; DIND = delayed ischemic neurological deficits; DSA = digital subtraction angiography; MIP = maximum-intensity projection; MTT = mean transit time; NPV = negative predictive value; PPV = positive predictive value; ROI = region of interest; TCD = transcranial Doppler sonography; TTP = time to peak; TTS = time to start; aSAH = aneurysmal subarachnoid hemorrhage; delayed ischemic neurological deficit; imaging; subarachnoid hemorrhage; transcranial Doppler sonography; vascular disorders; vasospasm