Disturbance of CT perfusion within 24 h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH

Takahashi, Yuichi; Sasahara, Atsushi; Yamazaki, Kei; Inazuka, Mayuko; Kasuya, Hidetoshi

doi:10.1007/s00701-017-3362-2

Cited by 11 publications

(11 citation statements)

References 23 publications

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“…44 A recent study also failed to associate CT perfusion to DCI, but found an association of lower perfusion to lower neurological grade on admission. 45 Although we would expect to find higher TTP values in patients who ultimately develop DCI, we found a paradoxical decrease of TTP in those patients in the early phase of SAH, albeit not significant. One explanation could be a false positive finding, and a small number of patients with DCI in our sample; another explanation could be the presence of comorbidities, such as cardiac failure, that could affect the velocity of arrival of the contrast, although we have no data to support this.…”

Section: Discussioncontrasting

confidence: 58%

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Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

Fragata

Alves

Papoila³

et al. 2019

Neuroradiol J

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Background Computed tomography (CT) perfusion has been studied as a tool to predict delayed cerebral ischemia (DCI) and clinical outcome in spontaneous subarachnoid hemorrhage (SAH). The purpose of the study was to determine whether quantitative CT perfusion performed within 72 hours after admission can predict the occurrence of DCI and clinical outcome as measured with a modified Rankin scale (mRS) at 3 months after ictus. Methods Cerebral perfusion was assessed in a prospective cohort of patients with acute SAH. CT perfusion parameters at <72 h post SAH were quantitatively measured in the main vascular territories and represented as whole-brain means. Spearman rank correlation coefficient and generalized additive regression models for binary outcome were used. Results A total of 66 patients underwent CT perfusion at <72 h. Poor clinical grade on admission was correlated with worse cerebral perfusion in all parameters. Multivariable analysis yielded an association of time to peak (TTP; odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.77, 1.02; p = 0.083) with the occurrence of DCI. We also found an association of TTP values with poor outcome, with an 8% increase in the odds of mRS > 3 for each one second increase in TTP at admission (OR = 1.08; 95% CI: 1.00, 1.17; p = 0.061). Conclusions We identified an association of early TTP changes with DCI and poor clinical outcome. However, there were no associations with cerebral blood flow or mean transit time and DCI/clinical outcome. CT perfusion still remains to be validated as a tool in predicting outcome in SAH.

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Section: Discussioncontrasting

confidence: 58%

“…44 A recent study also failed to associate CT perfusion to DCI, but found an association of lower perfusion to lower neurological grade on admission. 45…”

Section: Discussionmentioning

confidence: 99%

Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

Fragata

Alves

Papoila³

et al. 2019

Neuroradiol J

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“…Unlike MTT, T max maps are obtained following deconvolution of an automated or user‐defined proximal arterial input function from the tissue time‐attenuation course to isolate a hypothetical tissue impulse response, 19 providing an estimation of macrovascular delay while removing confounds related to the bolus injection or to more proximal (eg, extracranial) sources of delay. A prior study by Takahashi et al demonstrated that whereas prolonged MTT in patients with aSAH was associated with changes in World Federation of Neurological Societies grade, there was no difference in average MTT between patients who developed delayed cerebral infarction (DCI) and those who did not 26 ; thus we felt a contemporary investigation into the utility of T max in this setting to be timely.…”

Section: Discussionmentioning

confidence: 87%

“…The relatively small sample size of 31 patients should also be considered when interpreting our results, although our study population was larger than the sample size of the majority of prior studies (range 2–41 patients). 9 , 25 , 26 The study population is somewhat unique in that all patients had a CTA, CTP, and DSA within a 24‐hour window. In addition, we evaluated our results both on a per‐study and a per‐vessel level, the latter of which increased the sample size to a more robust 540 segments.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Allen

Prater

Kallas

et al. 2022

JAHA

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Background Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well‐known technical limitations. We evaluated fully automated, thresholded time‐to‐maxima of the tissue residue function ( T max ) for determination of vasospasm following aneurysmal subarachnoid hemorrhage. Methods and Results Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid hemorrhage undergoing computed tomography angiography (CTA), computed tomography perfusion, and digital subtraction angiography (DSA) within 24 hours. T max at 4, 6, 8, and 10 s was generated using RAPID (iSchemaView Inc., Menlo Park, CA). Dual‐reader CTA and computed tomography perfusion interpretations were compared for patients with and without vasospasm on DSA (DSA+ and DSA−). Logistic regression models were developed using CTA and T max as input predictors and DSA vasospasm as outcome in adjusted and unadjusted models. Imaging studies from all 31 subjects (mean age 47.3±11.1, 77% female, 65% with single aneurysm with mean size of 6.0±2.9 mm) were included. Vasospasm was identified in 42 segments on DSA and 59 segments on CTA, with significant associations across individual vessel segments ( P <0.001). In adjusted analyses, DSA vasospasm was associated with CTA (odds ratio [OR], 2.43; 95% CI, 0.94–6.32; P =0.068) as well as territory‐specific T max >6 seconds delays (OR, 3.57; 95% CI, 1.36–9.35; P =0.009). Sensitivity/specificity for DSA vasospasm was 31%/91% for CTA, 26%/89% for T max >6 seconds, and 12%/99% for CTA+ T max >6 seconds. Conclusions CTA and T max offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity.

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“…It corroborates with the previous report of our group suggesting that the development of vasospasm after aSAH may be determined solely by the presence of blood clots in the subarachnoid cisterns and not associated with the primary brain injury after aneurysm rupture. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Cerebral vasospasm and hypoperfusion after traumatic brain injury: Combined CT angiography and CT perfusion imaging study

Maegawa¹,

Sasahara²,

Ohbuchi³

et al. 2021

Surgical Neurology International

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Background: Timely identification of the cerebral perfusion abnormalities after traumatic brain injury (TBI) is highly important. The objective of this study was the evaluation of the post traumatic vasospasm and cerebral hypoperfusion with the serial combined CT angiography (CTA) and CT perfusion (CTP) imaging examinations. Methods: The case series comprised 25 adult patients with closed TBI accompanied by various types of intracranial hematoma. Emergency surgery was done in 15 cases (60%). Combined CTA and CTP were performed on days 0 (D0) and 7 ± 1 (D7) after trauma. Results: CTA on D0 did not demonstrate vasospasm in any case but revealed it on D7 in 9 patients (36%). In the multivariate analysis, only the presence of subarachnoid hemorrhage (SAH) on D7 had confirmed a significant association with the development of vasospasm (P = 0.0201). Cerebral hypoperfusion at least in one evaluated brain region was noted on D0 and D7 in 76% and 60% of patients, respectively, and showed highly variable spatial distribution and temporal development. Treatment results were not associated with the presence of vasospasm (P = 0.7337) or the number of brain regions affected by hypoperfusion on D0 (P = 0.2285), but the number of brain regions affected by hypoperfusion on D7 was significantly greater in cases of unfavorable outcome (P = 0.0187). Conclusion: Vasospasm is merely related to SAH sustained at the subacute stage of TBI, but its spatial and temporary interrelationships with the post traumatic cerebral hypoperfusion are complex. Serial combined CTA and CTP examinations may facilitate monitoring of perfusion abnormalities and treatment guidance.

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Disturbance of CT perfusion within 24 h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH

Cited by 11 publications

References 23 publications

Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

Computed tomography perfusion as a predictor of delayed cerebral ischemia and functional outcome in spontaneous subarachnoid hemorrhage: A single center experience

Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Cerebral vasospasm and hypoperfusion after traumatic brain injury: Combined CT angiography and CT perfusion imaging study

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