title: Application of Blood-Brain Barrier Permeability Imaging in Global Cerebral Edema.
abstract: Blood-brain barrier permeability is not routinely evaluated in the clinical setting. Global cerebral edema occurs after SAH and is associated with BBB disruption. Detection of global cerebral edema using current imaging techniques is challenging. Our purpose was to apply blood-brain barrier permeability imaging in patients with global cerebral edema by using extended CT perfusion.
  
  
  
  Patients with SAH underwent CTP in the early phase after aneurysmal rupture (days 0-3) and were classified as having global cerebral edema or nonglobal cerebral edema using established noncontrast CT criteria. CTP data were postprocessed into blood-brain barrier permeability quantitative maps of PS (permeability surface-area product), K(trans) (volume transfer constant from blood plasma to extravascular extracellular space), Kep (washout rate constant of the contrast agent from extravascular extracellular space to intravascular space), VE (extravascular extracellular space volume per unit of tissue volume), VP (plasmatic volume per unit of tissue volume), and F (plasma flow) by using Olea Sphere software. Mean values were compared using t tests.
  
  
  
  Twenty-two patients were included in the analysis. Kep (1.32 versus 1.52, P < .0001), K(trans) (0.15 versus 0.19, P < .0001), VP (0.51 versus 0.57, P = .0007), and F (1176 versus 1329, P = .0001) were decreased in global cerebral edema compared with nonglobal cerebral edema while VE (0.81 versus 0.39, P < .0001) was increased.
  
  
  
  Extended CTP was used to evaluate blood-brain barrier permeability in patients with SAH with and without global cerebral edema. Kep is an important indicator of altered blood-brain barrier permeability in patients with decreased blood flow, as Kep is flow-independent. Further study of blood-brain barrier permeability is needed to improve diagnosis and monitoring of global cerebral edema.
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.) jai9018@nyp.org.
authors.forename: J
authors.identifier: 0000-0002-6470-5400
authors.initials: J
authors.lastname: Ivanidze
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: O N
authors.identifier: 0000-0002-2622-7479
authors.initials: ON
authors.lastname: Kallas
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: A
authors.identifier: 0000-0003-2816-0340
authors.initials: A
authors.lastname: Gupta
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: E
authors.identifier: 0000-0002-3645-7964
authors.initials: E
authors.lastname: Weidman
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: H
authors.identifier: 0000-0002-6251-5769
authors.initials: H
authors.lastname: Baradaran
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: D
authors.identifier: 0000-0001-5023-0769
authors.initials: D
authors.lastname: Mir
authors.affiliation: Healthcare Policy and Research (A.Giambrone).
authors.forename: A
authors.identifier: 0000-0003-4498-8471
authors.initials: A
authors.lastname: Giambrone
authors.affiliation: Neurology (A.Z.S.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
authors.forename: A Z
authors.identifier: 0000-0001-8703-9108
authors.initials: AZ
authors.lastname: Segal
authors.affiliation: Department of Neurology (J.C.), New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: J
authors.identifier: 0000-0002-5893-8531
authors.initials: J
authors.lastname: Claassen
authors.affiliation: From the Departments of Radiology (J.I., O.N.K., A.Gupta, E.W., H.B., D.M., P.C.S.).
authors.forename: P C
authors.identifier: 0000-0002-9633-3699
authors.initials: PC
authors.lastname: Sanelli
mesh_terms: D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000209:etiology; D002199:Capillary Permeability / Q000502:physiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D055420:Perfusion Imaging / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media