Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Abstract

Blood–brain barrier (BBB) dysfunction has been implicated in ischemic risk following aneurysmal subarachnoid hemorrhage (aSAH), but never directly imaged. We prospectively examined whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). Global MR-derived BBB permeability (Ktrans) was significantly higher in aSAH patients who subsequently developed DCI (five patients; 2.28 ± 0.09 × 10−3 min−1) compared to those who experienced radiographic vasospasm only (three patients; 1.85 ± 0.12 × 10−3 min−1; p < 0.05), or no vasospasm/ischemia (eight patients; 1.74 ± 0.07 × 10−3 min−1; p < 0.01). Ktrans > 2 × 10−3 min−1 predicted development of DCI (AUC = 0.98, 95% CI: 0.93–1). Global BBB dysfunction following aSAH is detectable with DCE-MR and predictive of ischemic risk.