Abstract
BackgroundDelayed cerebral ischemia increases mortality and morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Various techniques are applied to detect cerebral vasospasm and hypoperfusion. Contrast-enhanced ultrasound perfusion imaging (UPI) is able to detect cerebral hypoperfusion in acute ischemic stroke. This prospective study aimed to evaluate the use of UPI to enable detection of cerebral hypoperfusion after aSAH.MethodsWe prospectively enrolled patients with aSAH and performed UPI examinations every second day after aneurysm closure. Perfusion of the basal ganglia was outlined to normalize the perfusion records of the anterior and posterior middle cerebral artery territory. We applied various models to characterize longitudinal perfusion alterations in patients with delayed ischemic neurologic deficit (DIND) across the cohort and predict DIND by using a multilayer classification model.ResultsBetween August 2013 and December 2015, we included 30 patients into this prospective study. The left–right difference of time to peak (TTP) values showed a significant increase at day 10–12. Patients with DIND demonstrated a significant, 4.86 times increase of the left–right TTP ratio compared with a mean fold change in patients without DIND of 0.9 times (p = 0.032).ConclusionsUPI is feasible to enable detection of cerebral tissue hypoperfusion after aSAH, and the left–right difference of TTP values is the most indicative result of this finding.
Highlights
Delayed cerebral ischemia (DCI) due to hypoperfusion in the course of cerebral vasospasm is, besides rebleeding, the leading cause of morbidity and mortality after initial aneurysmal rupture in subarachnoid hemorrhage (SAH) [1, 2]
Even though there is a pronounced variance of ultrasound perfusion imaging (UPI) measurements of the cohort, the parameter LRDiff showed a robust differentiation between affected patients and nonaffected patients
Prediction Model for delayed ischemic neurologic deficit (DIND) Based on UPI Records LRDiff of time to peak (TTP) was found to predict tissue hypoperfusion, the overall accuracy was limited because of a pronounced heterogeneity within the cohort
Summary
Delayed cerebral ischemia (DCI) due to hypoperfusion in the course of cerebral vasospasm is, besides rebleeding, the leading cause of morbidity and mortality after initial aneurysmal rupture in subarachnoid hemorrhage (SAH) [1, 2]. UPI might be a useful screening tool in patients with SAH to assess cerebral perfusion We performed this prospective study to evaluate the capability of contrastenhanced UPI to enable the detection of cerebral hypoperfusion in patients with SAH. Contrast-enhanced ultrasound perfusion imaging (UPI) is able to detect cerebral hypoperfusion in acute ischemic stroke. This prospective study aimed to evaluate the use of UPI to enable detection of cerebral hypoperfusion after aSAH
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