Repetitive CT perfusion for detection of cerebral vasospasm-related hypoperfusion in aneurysmal subarachnoid hemorrhage.

Vulcu, Sonja; Wagner, Franca; Fernandes Santos, Ana Mafalda; Reitmeir, Raluca; Soell, Nicole; Schöni, Daniel Stephan; Fung, Christian; Wiest, Roland; Raabe, Andreas; Beck, Jürgen; Z'Graggen, Werner Josef (2019). Repetitive CT perfusion for detection of cerebral vasospasm-related hypoperfusion in aneurysmal subarachnoid hemorrhage. World neurosurgery, 121, e739-e746. Elsevier 10.1016/j.wneu.2018.09.208

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BACKGROUND Delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (aSAH) still remains the leading cause of disability in patients that survive the initial ictus. It has been shown that CT perfusion (CTP) imaging can detect hypoperfused brain areas. The aim of this study was to evaluate if a single acute CTP examination at time of neurological deterioration is sufficient or if an additional baseline CTP increases diagnostic accuracy. METHODS Retrospective analysis of acute and baseline (within 24 hours after aneurysm treatment) CTP examinations of patients with neurological deterioration because of vasospasm-related hypoperfusion. Patients without clinical deterioration during the vasospasm period served as controls. The following CTP parameters were analyzed for predefined brain regions: time to drain (TTD), mean transit time, time to peak, cerebral blood flow and volume. RESULTS 33 patients with and 23 without neurological deterioration were included. Baseline CTP examination did not ameliorate diagnostic accuracy of the acute CTP examination in symptomatic patients. The same was true for inter-hemispheric comparison of perfusion parameters of the acute examination. The CTP parameter with the highest diagnostic yield was TTD of the symptomatic brain region (threshold value 4.7 sec, sensitivities 97 %, specificities 96 %). CONCLUSIONS Acute CTP examination in case of suspected vasospasm-induced neurological deterioration after aSAH has the highest diagnostic accuracy to detect misery perfusion. Additional baseline CTP is not needed. The most sensitive parameter to detect critically perfused brain areas is TTD.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Vulcu, Sonja; Wagner, Franca; Fernandes Santos, Ana Mafalda; Reitmeir, Raluca; Soell, Nicole; Schöni, Daniel Stephan; Fung, Christian; Wiest, Roland; Raabe, Andreas; Beck, Jürgen and Z'Graggen, Werner Josef

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1878-8750

Publisher:

Elsevier

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

22 Oct 2018 10:35

Last Modified:

10 Oct 2019 02:30

Publisher DOI:

10.1016/j.wneu.2018.09.208

PubMed ID:

30308346

Uncontrolled Keywords:

CT perfusion parameters cerebral vasospasm delayed cerebral ischemia misery perfusion subarachnoid hemorrhage

BORIS DOI:

10.7892/boris.120552

URI:

https://boris.unibe.ch/id/eprint/120552

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