Aims and objectives
After aneurysmal subarachnoid hemorrage (aSAH),
hydrocephalus or craniotomy can cause perfusional defects.
The delayed arrival of contrast may overestimate the ischemic area in DCI after aSAH.
Aim of this work is to analyse the diagnostic accuracy of CTP finding in DCI and final outcome after SAH.
Methods and materials
We included 415 consecutive patients with symptomatic aSAH (mean age 61,8y,
april 2009-september 2017),
who underwent NCCT/CTP/CTA for imaging and subsequent endovascular treatment with permanent exclusion.
Clinical deterioration after aSAH were categorized into DCI and no DCI.
CTP maps were automatically calculated tracer delay-sensitive algorithms and were also visually assessed for the presence of perfusional defects by two independent experienced readers.
Hunt-Hess score at presentation,
vasospasm evaluated with TICI and CTP were correlated using a multiple logistic regression analysis (p<0.005).
For diagnosing DCI on the CTP maps shows a significant reduction of CBV and increase of MTT (356/415 patients 85.83%) suggestive for vasospasm that lead poor outcome 12.64% (45/356); the positive predictive values (PPVs) were 0.81 (0.58 to 0.95) for the MTT and negative predictive values (NPVs) 0.57 (0.18 TO 0.90) for the detection of microangiopaty in the DCI group.
Patients with severe vasospasm on CTA,
have PPVs and NPVs values that did not significantly differ on MTT and CBF analysis.
CTP/CTA can be used for qualitative evaluation of DCI in patients with aSAH but more efforts are needed to evaluate the exact relationships between imaging and outcome.
Chief of Interventional and Vascular Radiology,
de Oliveira Manoel AL,
Early CT perfusion changes and blood-brain barrier permeability after aneurysmal subarachnoid hemorrhage.
2015 Apr 14.
Epub ahead of print.
Endothelin-1 expression and alterations of cerebral microcirculation after experimental subarachnoid hemorrhage.
Epub 2014 Oct 5.
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