title: Prognostic Assessment of Aneurysmal Subarachnoid Patients with WFNS Grade V by CT Perfusion on Arrival.
abstract: BACKGROUND
  The prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) depends on their condition on arrival at the hospital. However, a small number of patients recover from an initially poor condition. We investigated the correlation between quantitative measures of computed tomography (CT) perfusion (CTP) on arrival and the outcomes of patients with World Federation of Neurosurgical Society (WFNS) grade V aSAH.
  
  
  METHODS
  We performed plain CT, CTP, and CT angiography (CTA) in all patients with aSAH on arrival. Aneurysms were surgically obliterated in patients with stable vital signs and the presence of a brain stem response. We measured the average mean transit time (aMTT) and compared it with the modified Rankin Scale (mRS) score at 1 month. Regions of interest were identified as 24 areas in the bilateral anterior, middle, and posterior cerebral artery territories and 2 areas in the basal ganglia.
  
  
  RESULTS
  A total of 57 patients were treated between 2007 and 2014. None of the 21 patients with aMTT >6.385 seconds achieved a favorable outcome, whereas 8 of the 36 patients with aMTT <6.385 seconds did achieve a favorable outcome (P = 0.015). Furthermore, comparing the number of areas showing a mean transit time (MTT) >7.0 seconds among the aforementioned 8 areas and mRS, favorable outcomes were not seen in 24 patients with more than 2 such areas (P = 0.009).
  
  
  CONCLUSIONS
  We cannot expect a favorable outcome for patients with WFNS grade V aSAH with aMTT >6.385 seconds or more than 2 of 8 areas with MTT >7.0 seconds.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. Electronic address: asasa7666@yahoo.co.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sasahara
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Koseki
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Hirota
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ohbuchi
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kasuya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000000981:diagnostic imaging; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT perfusion; Prognosis; Subarachnoid hemorrhage