Disturbance of CT perfusion within 24h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH.

Abstract

Delayed cerebral ischemia (DCI) is a serious complication following aneurysmal SAH (aSAH) and remains a leading cause of morbidity and mortality. We investigated whether data from CT perfusion (CTP) within 24h after onset are associated with DCI and its outcome. We retrospectively examined plain CT, CTP, and CT angiography (CTA) of aSAH patients on arrival. We measured the average mean transit time (aMTT) and compared it with several clinical factors, such as the age, WFNS grade, Fisher group, delayed cerebral infarction, cerebral vasospasm, and modified Rankin scale (mRS), at 1 month. Regions of interest (ROIs) were quantitatively determined in cortical and two basal ganglia areas. Delayed cerebral ischemia (DCI) developed in 11 patients and cerebral vasospasm in 28 patients out of a total of 86 aSAH patients scanned within 24h after onset. The average MTT was correlated with the WFNS grade (p=0.000), but not mRS (p=0.128), age (p=0.759), DCI (p=0.669), or cerebral vasospasm (p=0.306). On the other hand, DCI was associated with the Fisher group (p=0.0056), mRS (p=0.0052), and cerebral vasospasm (p=0.000). Moreover, there were no significant differences in the average MTT within 24h after onset between territories with and without DCI, or between patients with and without DCI. The current findings suggest that disturbance of CT perfusion soon after the onset is associated with the WFNS grade but not with the development of DCI. Delayed cerebral ischemia may be solely caused by cerebral vasospasm due to a clot in the cistern, but not associated with early brain injury.