Abstract
PurposeThe technique of color-coding blood flow analysis was used to explore the correlation between the microcirculatory hemodynamic changes on digital subtraction angiography (DSA) images in patients with aneurysmal subarachnoid hemorrhage (SAH) at the early stage and functional outcomes at discharge.MethodsData of 119 patients who underwent DSA examination due to SAH were retrospectively analyzed. The following hemodynamic parameters of the four region of interests (ROIs) [an ophthalmic segment of the internal carotid artery (ICA), frontal and parietal lobe, and superior sagittal sinus] were analyzed: the time-to-peak (TTP), the area under the curve (AUC), the full width at half maximum (FWHM), mean transit time (MTT), and circulation time. Multifactor regression analysis was performed to explore the correlation between the hemodynamic parameters and functional outcomes in patients at discharge.ResultsOf 119 patients with SAH, good and poor outcomes were found in 83 (69.7%) and 36 (30.3%) patients, respectively. The hemodynamic parameters including the FWHM, relative TTP (rTTP), and circulation time were significantly correlated with the Hunt–Hess grade (p < 0.005, p = 0.03, and p < 0.005) and the World Federation of Neurological Societies Scale grade (p < 0.005, p = 0.02, and p = 0.01). The FWHM was significantly prolonged with the increase of modified Fisher grade (p = 0.02). The multifactor analysis showed that the FWHM [odds ratio (OR) 17.56, 95% CI: 1.13–272.03, p = 0.04] was an independent risk factor predicting the functional outcomes in patients at discharge.ConclusionThe technique of color-coding blood flow analysis could be suitable for the qualified evaluation of disease conditions at an early stage of SAH as well as the prediction of outcomes.
Highlights
Aneurysmal subarachnoid hemorrhage (SAH) is a critical disease with high mortality and disability rates
The comparison of the region of interest (ROI) at bilateral frontal lobes showed that the hemodynamic parameters, including maximal slope (MS) wash-in, MS washout, full width at half maximum (FWHM), relative MTT (rMTT), relative TTP (rTTP), area under curve (AUC), and peak density, were not significantly different (p > 0.05)
These findings indicated that the FWHM calculated from the color-coding flow analysis based on 2D-digital subtraction angiography (DSA) has the potential to characterize early microcirculatory changes in acute patients with SAH and predict their clinical outcomes during the initial surgery procedure, which could save a lot of time and suggest appropriate postoperation care delivery
Summary
Aneurysmal subarachnoid hemorrhage (SAH) is a critical disease with high mortality and disability rates. Increasing fundamental and clinical research has suggested that early brain injury is the most critical cause of delayed neurological dysfunction, mortality and disability in patients [1,2,3,4,5,6]. Previous studies showed that the decrease of cerebral blood flow (CBF) was associated with the increase of mean transit time (MTT), delayed cerebral ischemia, and poor prognoses [12,13,14,15]. All these methods require patients to stay in specific examination rooms, which involve increased waiting time and irradiation dosages. Such methods may not be applicable for patients with SAH requiring emergent surgeries or with critical disease conditions
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