Computed Tomographic Perfusion in the Management of Aneurysmal Subarachnoid Hemorrhage: New Application of an Existent Technique

Neurosurgery ◽  
2005 ◽  
Vol 56 (2) ◽  
pp. 304-317 ◽  
Author(s):  
Mark R. Harrigan ◽  
Christopher R. Magnano ◽  
Lee R. Guterman ◽  
L Nelson Hopkins
Keyword(s):  
Cerebral Ischemia ◽  
Blood Volume ◽  
Perfusion Imaging ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Computed Tomographic ◽  
Time To Peak ◽  
Ct Perfusion Imaging

Abstract OBJECTIVE: Cerebral blood flow (CBF) alterations are common after aneurysmal subarachnoid hemorrhage (SAH). Treatment of delayed cerebral ischemia in this setting depends on timely and accurate diagnosis. Techniques to measure cerebral blood flow are useful and important. Computed tomographic (CT) perfusion imaging is a technique for the measurement of CBF, cerebral blood volume, and time to peak. It is a fast and inexpensive brain imaging modality that offers promise in the management of patients with SAH. METHODS: CT perfusion imaging was performed in 10 patients with aneurysmal SAH when neurological changes raised suspicions of cerebral ischemia. Quantitative values for CBF, cerebral blood volume, and time to peak were obtained in each study. The case history, CT perfusion results, and an analysis of how patient management was influenced are presented for each patient. RESULTS: A total of 17 CT perfusion studies were performed. Five studies showed evidence of cerebral ischemia, leading to endovascular treatment of vasospasm. Eight studies excluded cerebral ischemia, and two studies identified cerebral hyperemia, resulting in adjustments in hyperdynamic therapy. CT perfusion was used to help predict a poor prognosis and withhold aggressive intervention in two patients with poor Hunt and Hess grades. Time-to-peak values identified regions of cerebral ischemia more readily than CBF or cerebral blood volume values. CONCLUSION: CT perfusion imaging can be used to identify patients with delayed cerebral ischemia after SAH and to guide medical and endovascular therapy. The findings can lead to alterations in patient management.

scholarly journals CT Perfusion and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 34 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Charlotte H P Cremers ◽  
Irene C van der Schaaf ◽  
Emerens Wensink ◽  
Jacoba P Greving ◽  
Gabriel J E Rinkel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Delayed Cerebral Ischemia ◽  
Mean Difference

Delayed cerebral ischemia (DCI) is at presentation a diagnosis per exclusionem, and can only be confirmed with follow-up imaging. For treatment of DCI a diagnostic tool is needed. We performed a systematic review to evaluate the value of CT perfusion (CTP) in the prediction and diagnosis of DCI. We searched PubMed, Embase, and Cochrane databases to identify studies on the relationship between CTP and DCI. Eleven studies totaling 570 patients were included. On admission, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-peak (TTP) did not differ between patients who did and did not develop DCI. In the DCI time-window (4 to 14 days after subarachnoid hemorrhage (SAH)), DCI was associated with a decreased CBF (pooled mean difference −11.9 mL/100 g per minute (95% confidence interval (CI): −15.2 to −8.6)) and an increased MTT (pooled mean difference 1.5 seconds (0.9–2.2)). Cerebral blood volume did not differ and TTP was rarely reported. Perfusion thresholds reported in studies were comparable, although the corresponding test characteristics were moderate and differed between studies. We conclude that CTP can be used in the diagnosis but not in the prediction of DCI. A need exists to standardize the method for measuring perfusion with CTP after SAH, and optimize and validate perfusion thresholds.

Comparison of cerebral blood volume and permeability in preoperative grading of intracranial glioma using CT perfusion imaging

2006 ◽  
Vol 48 (10) ◽  
pp. 773-781 ◽  
Author(s):  
Bei Ding ◽  
Hua Wei Ling ◽  
Ke Min Chen ◽  
Hong Jiang ◽  
Yan Bo Zhu
Keyword(s):  
Blood Volume ◽  
Perfusion Imaging ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Ct Perfusion Imaging

scholarly journals Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3

2020 ◽  
Vol 40 (10) ◽  
pp. 1966-1974 ◽  
Author(s):  
Vaishnavi L Rao ◽  
Michael Mlynash ◽  
Søren Christensen ◽  
Amarnath Yennu ◽  
Stephanie Kemp ◽  
...  
Keyword(s):  
Blood Volume ◽  
Perfusion Imaging ◽  
Intensity Ratio ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Ct Perfusion Imaging

We previously demonstrated that in the DEFUSE 3 trial, the union of the baseline core and the 24-h Tmax > 6 s perfusion lesion predicts the infarct volume at 24 h. Presently, we assessed if collateral robustness measured by the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index accounts for the variance in these predictions. DEFUSE 3 patients underwent MRI/CT perfusion imaging at baseline and 24 h post-randomization. We compared baseline and follow-up HIR and CBV index across subgroups stratified by differences between predicted and observed 24-h infarct volumes. Of 123 eligible patients, 34 with 24-h infarcts larger than predicted had less favorable collaterals at baseline (HIR 0.43 vs. 0.32, p = 0.006; CBV Index 0.78 vs. 0.85, p = 0.001) and 24 h (HIR 0.56 vs. 0.07, p = 0.004; CBV Index 0.47 vs. 0.73, p = 0.006) compared to 71 patients with more accurate infarct volume prediction. Eighteen patients with 24-h infarcts smaller than predicted had similar baseline collateral scores but more favorable 24-h CBV indices (0.81 vs. 0.73, p = 0.040). Overall, patients with 24-h infarcts larger than predicted had evidence of less favorable baseline collaterals that fail within 24 h, while patients with 24-h infarcts smaller than predicted typically had favorable collaterals that persisted for 24 h.

scholarly journals Evaluating CT Perfusion Using Outcome Measures of Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage

2012 ◽  
Vol 34 (2) ◽  
pp. 292-298 ◽  
Author(s):  
P.C. Sanelli ◽  
N. Anumula ◽  
C.E. Johnson ◽  
J.P. Comunale ◽  
A.J. Tsiouris ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Outcome Measures ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia

Abstract T P20: Correlation Between Whole Brain Ct Perfusion Maps And Non-contrast Ct Alberta Stroke Program Early Ct Score (aspects) In Patients Undergoing Acute Endovascular Stroke Interventions

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Simon Morr ◽  
Maxim Mokin ◽  
Ashish Sonig ◽  
Kenneth Snyder ◽  
Adnan Siddiqui ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Pearson Correlation ◽  
Volume Data ◽  
Post Intervention ◽  
Whole Brain ◽  
Brain Ct ◽  
Time To Peak

Introduction: Tools for evaluating risk of post-intervention risk hemorrhage in the setting of acute stroke include a noncontrast head CT based Alberta Stroke Program Early CT score (ASPECTS) and contrasted CT based perfusion plots. The correlation between these parameters is unknown. Methods: We performed a retrospective analysis of a prospectively collected endovascular stroke database of patients with M1 middle cerebral artery occlusion who underwent endovascular recanalization. We reviewed admission preintervention noncontrast CT for Alberta Stroke Program Early CT score (ASPECTS) and 320-detector row whole brain CT perfusion parameters (Cerebral blood volume and time to peak). Pearson correlation was determined between cerebral blood volume on the side of the stroke and ASPECTS. Results: ASPECTS and CT perfusion map were identified in 45 and 43 patients respectively. Statistically significant correlation was found between ASPECTS and cerebral blood volume data on CT perfusion MAP. (p=0.034, r=-0.28). The correlation coefficient is very weak. No correlation could be found between time to peak and ASPECTS. Conclusion: A statistically significant, but weak correlation exists between ASPECTS and CBV. Further research is needed to assess the physiological meaning of diverse imaging modalities utilized in the acute stroke setting.

scholarly journals Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

2015 ◽  
Vol 57 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Charlotte H. P. Cremers ◽  
Jan Willem Dankbaar ◽  
Mervyn D. I. Vergouwen ◽  
Pieter C. Vos ◽  
Edwin Bennink ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia
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