scholarly journals CT Perfusion and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 34 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Charlotte H P Cremers ◽  
Irene C van der Schaaf ◽  
Emerens Wensink ◽  
Jacoba P Greving ◽  
Gabriel J E Rinkel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Delayed Cerebral Ischemia ◽  
Mean Difference

Delayed cerebral ischemia (DCI) is at presentation a diagnosis per exclusionem, and can only be confirmed with follow-up imaging. For treatment of DCI a diagnostic tool is needed. We performed a systematic review to evaluate the value of CT perfusion (CTP) in the prediction and diagnosis of DCI. We searched PubMed, Embase, and Cochrane databases to identify studies on the relationship between CTP and DCI. Eleven studies totaling 570 patients were included. On admission, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-peak (TTP) did not differ between patients who did and did not develop DCI. In the DCI time-window (4 to 14 days after subarachnoid hemorrhage (SAH)), DCI was associated with a decreased CBF (pooled mean difference −11.9 mL/100 g per minute (95% confidence interval (CI): −15.2 to −8.6)) and an increased MTT (pooled mean difference 1.5 seconds (0.9–2.2)). Cerebral blood volume did not differ and TTP was rarely reported. Perfusion thresholds reported in studies were comparable, although the corresponding test characteristics were moderate and differed between studies. We conclude that CTP can be used in the diagnosis but not in the prediction of DCI. A need exists to standardize the method for measuring perfusion with CTP after SAH, and optimize and validate perfusion thresholds.

Computed Tomographic Perfusion in the Management of Aneurysmal Subarachnoid Hemorrhage: New Application of an Existent Technique

Neurosurgery ◽  
2005 ◽  
Vol 56 (2) ◽  
pp. 304-317 ◽  
Author(s):  
Mark R. Harrigan ◽  
Christopher R. Magnano ◽  
Lee R. Guterman ◽  
L Nelson Hopkins
Keyword(s):  
Cerebral Ischemia ◽  
Blood Volume ◽  
Perfusion Imaging ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Computed Tomographic ◽  
Time To Peak ◽  
Ct Perfusion Imaging

Abstract OBJECTIVE: Cerebral blood flow (CBF) alterations are common after aneurysmal subarachnoid hemorrhage (SAH). Treatment of delayed cerebral ischemia in this setting depends on timely and accurate diagnosis. Techniques to measure cerebral blood flow are useful and important. Computed tomographic (CT) perfusion imaging is a technique for the measurement of CBF, cerebral blood volume, and time to peak. It is a fast and inexpensive brain imaging modality that offers promise in the management of patients with SAH. METHODS: CT perfusion imaging was performed in 10 patients with aneurysmal SAH when neurological changes raised suspicions of cerebral ischemia. Quantitative values for CBF, cerebral blood volume, and time to peak were obtained in each study. The case history, CT perfusion results, and an analysis of how patient management was influenced are presented for each patient. RESULTS: A total of 17 CT perfusion studies were performed. Five studies showed evidence of cerebral ischemia, leading to endovascular treatment of vasospasm. Eight studies excluded cerebral ischemia, and two studies identified cerebral hyperemia, resulting in adjustments in hyperdynamic therapy. CT perfusion was used to help predict a poor prognosis and withhold aggressive intervention in two patients with poor Hunt and Hess grades. Time-to-peak values identified regions of cerebral ischemia more readily than CBF or cerebral blood volume values. CONCLUSION: CT perfusion imaging can be used to identify patients with delayed cerebral ischemia after SAH and to guide medical and endovascular therapy. The findings can lead to alterations in patient management.

scholarly journals P.116 Predicting cerebral vasospasm following aneurysmal subarachnoid hemorrhage is still an imperfect science

2019 ◽  
Vol 46 (s1) ◽  
pp. S44
Author(s):  
GE Pickett ◽  
MH Schmidt ◽  
JS Shankar
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Delayed Cerebral Ischemia ◽  
Anterior Communicating Artery ◽  
Unexpected Finding ◽  
Fisher Grade

Background: Cerebral vasospasm is a leading cause of neurological disability following aneurysmal subarachnoid hemorrhage (aSAH). Clinical features associated with vasospasm development include blood burden on CT, neurological status, age and aneurysm location. Early cerebral CT perfusion (CTP) scanning in aSAH may be an independent predictor of vasospasm and/or delayed cerebral ischemia (DCI). Methods: Forty-one patients with aSAH were prospectively enrolled. Baseline data collected included WFNS grade, loss of consciousness at ictus, and modified Fisher grade. CTP was obtained at baseline and on day 6 post SAH. Cerebral blood volume, cerebral blood flow and mean transit time were measured. DCI was confirmed by a combination of clinical assessments, non-contrast CT and CTP. Radiological vasospasm was assessed with CT angiography. Results: Despite 80% of patients having a modified Fisher grade 3 or 4 aSAH, one-third presenting with ictal LOC and half having anterior communicating artery aneurysms, only one patient developed clinical evidence of vasospasm/DCI. Two others had asymptomatic radiological vasospasm. CTP parameters did not differ between groups defined by clinical predictors. Conclusions: In an unexpected finding, clinical and radiological vasospasm were very uncommon in this cohort. Clinical predictive variables correlated poorly with development of vasospasm. CTP may help refine the model but further work is needed.

scholarly journals Evaluating CT Perfusion Using Outcome Measures of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage

2012 ◽  
Vol 34 (2) ◽  
pp. 292-298 ◽  
Author(s):  
P.C. Sanelli ◽  
N. Anumula ◽  
C.E. Johnson ◽  
J.P. Comunale ◽  
A.J. Tsiouris ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Outcome Measures ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia

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

2019 ◽  
Vol 32 (3) ◽  
pp. 179-188 ◽  
Author(s):  
Isabel Fragata ◽  
Marta Alves ◽  
Ana Luísa Papoila ◽  
Ana Paiva Nunes ◽  
Patrícia Ferreira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Clinical Outcome ◽  
Cerebral Perfusion ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Multivariable Analysis ◽  
Delayed Cerebral Ischemia ◽  
Spontaneous Subarachnoid Hemorrhage

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.

scholarly journals Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

2015 ◽  
Vol 57 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Charlotte H. P. Cremers ◽  
Jan Willem Dankbaar ◽  
Mervyn D. I. Vergouwen ◽  
Pieter C. Vos ◽  
Edwin Bennink ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia
Sign in / Sign up

Export Citation Format

Share Document