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European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Neuro

Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

Authors: Christine Rodriguez-Régent, Monia Hafsa, Guillaume Turc, Wagih Ben Hassen, Myriam Edjlali, Alain Sermet, Nathalie Laquay, Denis Trystram, Fawaz Al-Shareef, Jean-Francois Meder, Bertrand Devaux, Catherine Oppenheim, Olivier Naggara

Published in: European Radiology | Issue 9/2016

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Abstract

Objectives

To prospectively evaluate the predictive value of cerebral perfusion–computerized tomography (CTP) parameters variation between day0 and day4 after aneurysmal subarachnoid haemorrhage (aSAH).

Methods

Mean transit time (MTT) and cerebral blood flow (CBF) values were compared between patients with delayed cerebral ischemia (DCI+ group) and patients without DCI (DCI- group) for previously published optimal cutoff values and for variations of MTT (ΔMTT) and of CBF (ΔCBF) values between day0 and day4. DCI+ was defined as a cerebral infarction on 3-months follow-up MRI.

Results

Among 47 included patients, 10 suffered DCI+. Published optimal cutoff values did not predict DCI, either at day0 or at day4. Conversely, ΔMTT and ΔCBF significantly differed between the DCI+ and DCI- groups, with optimal ΔMTT and ΔCBF values of 0.91 seconds (83.9 % sensitivity, 79.5 % specificity, AUC 0.84) and -7.6 mL/100 g/min (100 % sensitivity, 71.4 % specificity, AUC 0.86), respectively. In multivariate analysis, ΔCBF (OR = 1.91, IC95% 1.13–3.23 per each 20 % decrease of ΔCBF) and ΔMTT values (OR = 14.70, IC95% 4.85–44.52 per each 20 % increase of ΔMTT) were independent predictors of DCI.

Conclusions

Assessment of MTT and CBF value variations between day0 and day4 may serve as an early imaging surrogate for prediction of DCI in aSAH.

Key points

• CT perfusion values are an imaging surrogate for prediction of DCI.
• Early variations (day0–day4) after aneurysmal subarachnoid haemorrhage predicted DCI.
• A CBF decrease of 7.6 mL/min/100 g predicted DCI with 100 % sensitivity.
• An MTT increase of 0.91 seconds predicted DCI with 83.9 % sensitivity.
• DCI risk multiplied by 2 per 20 % ΔCBF decrease and by 15 per 20 % ΔMTT increase.
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Metadata
Title
Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage
Authors
Christine Rodriguez-Régent
Monia Hafsa
Guillaume Turc
Wagih Ben Hassen
Myriam Edjlali
Alain Sermet
Nathalie Laquay
Denis Trystram
Fawaz Al-Shareef
Jean-Francois Meder
Bertrand Devaux
Catherine Oppenheim
Olivier Naggara
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4135-z

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