Monitoring cerebral perfusion after subarachnoid hemorrhage using CT

Nabavi, Darius G.; LeBlanc, L M; Baxter, Bruce W.; Lee, D H; Fox, Allan J.; Lownie, Stephen P.; Ferguson, G. G.; Craen, Rosemary A.; Gelb, Adrian W.; Lee, T Y

doi:10.1007/s002340000434

Cited by 89 publications

(61 citation statements)

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“…[22] Our quantitative perfusion values were within the range described by other groups. [17,23] Also, our semiquantitative analyses were in the same line as the quantitative findings, which further supports the validity of our quantitative measures.…”

Section: Discussionsupporting

confidence: 85%

“…Also, our results correspond with the results in two articles measuring cerebral perfusion in the first 3 weeks after SAH. [17,18] The concept of impaired autoregulation mechanisms on admission in patients who later develop DCI has also been described in other articles. [4,7,9,13,15,19] This study also showed that CTP is a practical and useful tool to compare perfusion on admission and during follow-up in patients with SAH since in 87% of patients a good quality admission and follow-up scan was obtained and no side effects of the CT scanning with contrast occurred.…”

Section: Discussionmentioning

confidence: 99%

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Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia

et al. 2008

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Introduction The pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is unclear. We assessed whether DCI relates to focal or global cerebral perfusion on admission and on follow-up imaging. Materials and methods Twenty-seven SAH patients underwent computed tomography (CT) perfusion (CTP) on admission and at clinical deterioration or 1 week after admission in clinically stable patients. We compared global and focal (least perfused territory) perfusion in patients with DCI (n=12), clinically stable patients (n=7), and patients with non-DCI-related deterioration (n=8). Results Global cerebral blood flow (CBF) increased on follow-up: 29% (95% confidence interval (CI) 15% to 43%) in patients with DCI, 12% (95%CI −1% to 25%) in stable patients, and 20% (95%CI 4% to 36%) in patients with non-DCI-related deterioration. Focal CBF decreased in patients with DCI, (−23%; 95%CI −58% to 12%) but increased in patients with non-DCI-related deterioration (23%; 95%CI −26% to 55%) and stable patients (7%; 95%CI −30% to 45%). On follow-up, global CBF was lower in patients with DCI (70.0 ml per 100 g/min) than in clinically stable patients (81.6; difference 11.6; 95%CI 0.8 to 22.5 ml per 100 g/min) but comparable to patients with non-DCI-related deterioration (67.6; difference −2.4; 95%CI −11.9 to 7.2 ml per 100 g/min). Focal CBF was lower in patients with DCI (30.7) than in clinically stable patients (53.6; difference 22.9; 95%CI 5.1 to 40.6 ml per 100 g/min) and patients with non-DCI-related deterioration (46.6; difference 15.9; 95%CI −2.6 to 28.4 ml per 100 g/min) Conclusion Our results suggest that DCI is more likely a focal than a global process.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia

et al. 2008

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“…5,11,13,17 In the current study, we have demonstrated the usefulness of CT perfusion in the diagnosis of critically ill patients with high-and low-grade SAH. It is particularly useful in the diagnosis of unconscious patients with SAH in whom a neurological examination could not be performed.…”

Section: Discussionmentioning

confidence: 61%

Utility of computed tomography perfusion in detection of cerebral vasospasm in patients with subarachnoid hemorrhage

Moftakhar

Rowley²,

Turk³

et al. 2006

FOC

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Object Digital subtraction (DS) angiography is the gold standard for detecting cerebral vasospasm after subarachnoid hemorrhage (SAH). Computed tomography (CT) perfusion is a recently developed modality for the evaluation of cerebral hemodynamics. This study was conducted to evaluate the potential of using CT perfusion to detect vasospasm in patients with SAH. Methods Fourteen patients between the ages of 41 and 66 years with aneurysmal SAH underwent 23 CT perfusion scans for suspected vasospasm. All patients underwent DS angiography within 12 hours of the CT perfusion scans. The presence of vasospasm on CT perfusion images was determined based on qualitative reading using color maps of mean transit time, cerebral blood flow, and cerebral blood volume as criteria. The presence or absence of vasospasm as retrospectively determined using CT perfusion was compared with DS angiography findings. Of the 23 CT perfusion scans performed, 21 (91%) were concordant with angiography findings in predicting the presence or absence of vasospasm. In 15 of 23 scans, the presence of vasospasm was detected on CT perfusion scans and confirmed on DS angiography studies. In two cases, vasospasm was revealed on DS angiography but was not confirmed on CT perfusion. The degree of agreement between CT perfusion and DS angiography for detection of vasospasm was high (κ = 0.8, p < 0.0001). Conclusions Computed tomography perfusion is an accurate, reliable, and noninvasive method to detect the presence or absence of vasospasm. It can be used as a tool to help guide the decision to pursue DS angiography with the intent to treat vasospasm.

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“…Not only marked narrowing of the large arteries but also microcirculatory changes, which were indicated by a prolonged CCT, affected cerebral ischemia during cerebral vasospasm. 17) Other studies have reported that delayed cerebral ischemia, which develops during delayed CVS, occurred in 11-49% of patients in whom no vasospasm was found on DSA, 2,3,28) suggesting the involvement of microcirculatory vasospasm. The factors involved in the mechanism responsible for the cerebral circulation disturbance that occurs prior to the development of delayed CVS appear to be ICP elevation and microcirculatory vasoconstriction.…”

Section: Discussionmentioning

confidence: 94%

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Honda

Sase

Yokota

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR] ). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.

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Monitoring cerebral perfusion after subarachnoid hemorrhage using CT

Cited by 89 publications

References 0 publications

Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia

Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia

Utility of computed tomography perfusion in detection of cerebral vasospasm in patients with subarachnoid hemorrhage

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

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