The value of perfusion computed tomography (PCT) imaging after aneurysmal subarachnoid hemorrhage: a review of the current data.

Abstract

The estimation of the extent of early brain injury (EBI) and sensitive detection of delayed cerebral ischemia (DCI) remains a major challenge in the context of aneurysmal subarachnoid hemorrhage (aSAH). Cerebral perfusion computed tomography (PCT) imaging is increasingly used as an additional diagnostic tool to monitor early brain injury as well as delayed cerebral ischemia after aSAH. Here, we review the current literature as well as the resulting implications and illustrate our institutional experience with PCT imaging in this context. The current literature on PCT imaging for SAH was identified based on a search of the PubMed database. Patient cohorts were dichotomized according to the time of PCT after ictus into early PCT (<72 h after ictus) and subsequent PCT (>72 h after ictus). The specific aspects and findings of PCT at different times are compared and discussed. Sixteen relevant publications were identified, nine of which focused on early PCT and seven on subsequent PCT diagnostics after aSAH. Early PCT provided relevant details on the extent of EBI and identified patients at risk for developing DCI, whereas subsequent PCT imaging facilitated the monitoring and detection of DCI. The present review demonstrates that PCT imaging is able to detect EBI as well as DCI in patients experiencing aSAH. As a consequence, this technique should be routinely implemented in monitoring strategies for this patient population.