Abstract
IntroductionDelayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. In patients with a deterioration clinically diagnosed as DCI, we investigated whether CT perfusion (CTP) can distinguish between reversible ischemia and ischemia progressing to cerebral infarction.MethodsFrom a prospectively collected series of aSAH patients, we included those with DCI, CTP on the day of clinical deterioration, and follow-up imaging. In qualitative CTP analyses (visual assessment), we calculated positive and negative predictive value (PPV and NPV) with 95 % confidence intervals (95%CI) of a perfusion deficit for infarction on follow-up imaging. In quantitative analyses, we compared perfusion values of the least perfused brain tissue between patients with and without infarction by using receiver-operator characteristic curves and calculated a threshold value with PPV and NPV for the perfusion parameter with the highest area under the curve.ResultsIn qualitative analyses of 33 included patients, 15 of 17 patients (88 %) with and 6 of 16 patients (38 %) without infarction on follow-up imaging had a perfusion deficit during clinical deterioration (p = 0.002). Presence of a perfusion deficit had a PPV of 71 % (95%CI: 48–89 %) and NPV of 83 % (95%CI: 52–98 %) for infarction on follow-up. Quantitative analyses showed that an absolute minimal cerebral blood flow (CBF) threshold of 17.7 mL/100 g/min had a PPV of 63 % (95%CI: 41–81 %) and a NPV of 78 % (95%CI: 40–97 %) for infarction.ConclusionsCTP may differ between patients with DCI who develop infarction and those who do not. For this purpose, qualitative evaluation may perform marginally better than quantitative evaluation.
Highlights
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage can be reversible or progress to cerebral infarction
Quantitative analyses showed that an absolute minimal cerebral blood flow (CBF) threshold of 17.7 mL/100 g/min had a PPV of 63 % (95%CI: 41–81 %) and a NPVof 78 % (95%CI: 40–97 %) for infarction
DCI is mainly a clinical diagnosis at onset based on exclusion of other causes of the deterioration and confirmed by follow-up imaging showing cerebral infarction, but recent studies have shown that CT perfusion (CTP) can be helpful to detect DCI at the time of clinical deterioration [7]
Summary
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) can be reversible or progress to cerebral infarction. DCI is mainly a clinical diagnosis at onset based on exclusion of other causes of the deterioration and confirmed by follow-up imaging showing cerebral infarction, but recent studies have shown that CT perfusion (CTP) can be helpful to detect DCI at the time of clinical deterioration [7]. It remains unknown if patients with reversible ischemia can be distinguished from patients with ischemia progressing to cerebral infarction. DCI can be Neuroradiology (2015) 57:897–902 assessed with CTP in different ways: qualitatively (with visual detection of a perfusion deficit) and with quantitative thresholds (both absolute and relative)
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