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

2006 ◽  
Vol 21 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Roham Moftakhar ◽  
Howard A. Rowley ◽  
Aquilla Turk ◽  
David B. Niemann ◽  
Beverly Aagaard Kienitz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Digital Subtraction ◽  
Noninvasive Method ◽  
Computed Tomography Perfusion ◽  
Intent To Treat

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.

scholarly journals Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

2020 ◽  
Vol 11 ◽  
pp. 233
Author(s):  
Koji Omoto ◽  
Ichiro Nakagawa ◽  
Fumihiko Nishimura ◽  
Shuichi Yamada ◽  
Yasushi Motoyama ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Delayed Cerebral Ischemia ◽  
Computed Tomography Perfusion

Background: Endovascular treatment (ET) can improve angiographic cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage, but was unrelated to clinical outcomes in previous analyses. Appropriate detection of CV and precise indications for ET are required. This study investigated whether changes in computed tomography perfusion (CTP) parameter can determine indications for ET in CV and predict its effectiveness. Methods: Participants comprised 140 patients who underwent neck clipping or coil embolization. CTP was performed a week after aneurysmal treatment or when clinical deterioration had occurred. Patients were divided into ET and non-ET groups by propensity score matching. In addition, the ET group was divided into subgroups with and without new cerebral infarction (CI). All CTP images in the three groups were retrospectively investigated qualitatively and quantitatively. CI was diagnosed from CT at 3 months postoperatively. Results: Of the 121 patients examined, 15 patients (11%) needed ET. In qualitative analysis, all ET group patients displayed extension of time-to-peak (TTP) at the region of vasospastic change, regardless of the presence of CI. Quantitative analysis showed significant decreases in cerebral blood volume (P < 0.01), cerebral blood flow (CBF) (P < 0.001), and extension in TTP (P < 0.01) in the ET group compared with the non-ET group. A significant decrease in CBF (P < 0.001) and extension in mean transit time (P < 0.001) was seen in the ET with CI subgroup compared with the ET without CI subgroup. Conclusion: CTP in the vasospastic period may be an indication for ET and predict the effectiveness of ET for CV to improve clinical outcomes.

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 Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 43 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Cheemun Lum ◽  
Matthew J. Hogan ◽  
John Sinclair ◽  
Shane English ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Middle Cerebral Artery ◽  
Transit Time ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Arterial Diameter ◽  
Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

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 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.

Convenience of the computed tomography perfusion method for cerebral vasospasm detection after subarachnoid hemorrhage

2007 ◽  
Vol 67 (6) ◽  
pp. 604-611 ◽  
Author(s):  
Ryuzaburo Kanazawa ◽  
Mitsuhisa Kato ◽  
Kazuya Ishikawa ◽  
Tsuneyoshi Eguchi ◽  
Akira Teramoto
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Computed Tomography Perfusion ◽  
Perfusion Method

Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans

1977 ◽  
Vol 46 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Robert L. Grubb ◽  
Marcus E. Raichle ◽  
John O. Eichling ◽  
Mokhtar H. Gado
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Blood Volume ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Neurological Deficits ◽  
Regional Cerebral Blood ◽  
Oxygen Utilization ◽  
Ruptured Intracranial Aneurysm ◽  
Regional Cerebral Blood Volume

✓ Forty-five studies of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional cerebral oxygen utilization (rCMRO2) were performed in 30 patients undergoing diagnostic cerebral angiography for evaluation of a subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Tracer methods employing radioactive oxygen-15 were used to measure rCBV, rCBF, and rCMRO2. The patient studies were divided into groups based on their neurological status and the presence or absence of cerebral vasospasm. Subarachnoid hemorrhage, with and without vasospasm, produced significant decreases in CBF and CMRO2. In general, patients with more severe neurological deficits, and patients with more severe degrees of vasospasm, had a more marked depression of CBF and CMRO2. The most striking finding was a significant (p < 0.001) increase in CBV (to 58% above normal) in patients with severe neurological deficits associated with severe cerebral vasospasm. This large increase suggests that cerebral vasospasm consists of constriction of the large, radiographically visible extraparenchymal vessels accompanied by a massive dilation of intraparenchymal vessels.

Abstract 3303: Detection of cerebral vasospasm using Dynamic CT: Analysis of Volume Perfusion CT Maps and 4D-CT Angiography

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Peter Schramm ◽  
Karoline Dolatowski ◽  
Ramona Schramm ◽  
Andreas Froelich ◽  
Ernst Klotz ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Relevant Information ◽  
Vessel Diameter ◽  
Perfusion Ct ◽  
Cerebral Hypoperfusion ◽  
Arterial Phase ◽  
Arterial Vasospasm ◽  
Stenotic Lesions

Introduction: Cerebral vasospasm with a raised risk for secondary ischemia is a frequent complication after subarachnoid hemorrhage (SAH). The early diagnosis of focal or global cerebral hypoperfusion is important in order to allow treatment before irreversible ischemic damage occurs (intensive care and/or neurointervention). We tested, whether the implementation of “whole brain” volume Perfusion CT (VPCT) for the examination of patients with suspected cerebral vasospasm delivers relevant information about the localization and characteristics of arterial vasospasm and the volume at risk of secondary infarction. Patients and Methods: Patients were eligible for this study, if they had been admitted to our department with suspicion of cerebral vasospasm due to SAH. Patients first received a non-contrast CT of the brain to exclude acute hydrocephalus. After that, VPCT was performed. CT angiographic axial and coronal maximum-intensity projections (MIP) were generated from thin slice recons of the VPCT dataset at peak arterial time. Images were assessed for presence of arterial vasospasm or occlusion and compared with conventional CTA or DSA. The distribution of ischemic lesions was analyzed on 3D perfusion parameter maps of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to drain (TTD). Results: 11 patients with SAH were examined with VPCT. In all patients, focal areas of cerebral hypoperfusion were detected on the color coded VPCT parameter maps. The highest sensitivity was found for MTT and TTD. Focal reductions of CBV strongly correlated with infarction on follow-up CT. 8 patients (73%) had focal stenotic lesions of intracranial artery segments due to vasospasm visible on the thin MIP reconstructions of the 4D CTA arterial phase. All of these stenotic lesions were also visible on conventional CTA or DSA, resulting in 100% sensitivity of the 4D CTA reconstructions. In 2 patients, balloon angioplasty of the vasospastic segments was performed subsequently; in both patients, VPCT showed normalization of both the perfusion maps and the vessel diameter afterwards. Conclusion: VPCT is a non-invasive method that allows detecting cerebral vasospasm in patients suffering from SAH. It has the potential to demonstrate brain areas with a focal perfusion deficit as well as vasospastic arterial segments. DSA will remain the gold standard for detection of cerebral vasospasm, but VPCT has the potential to improve diagnosis and treatment decisions in patients suffering from vasospasm due to SAH.

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