The value of computed tomography perfusion & transcranial Doppler in early diagnosis of cerebral vasospasm in aneurysmal & traumatic subarachnoid hemorrhage

Object Digital subtraction (DS) angiography is the gold standard for detecting cerebral vasospasm after subarachnoid hemorrhage (SAH). Computed tomography (CT) perfusion is a recently developed modality for the evaluation of cerebral hemodynamics. This study was conducted to evaluate the potential of using CT perfusion to detect vasospasm in patients with SAH. Methods Fourteen patients between the ages of 41 and 66 years with aneurysmal SAH underwent 23 CT perfusion scans for suspected vasospasm. All patients underwent DS angiography within 12 hours of the CT perfusion scans. The presence of vasospasm on CT perfusion images was determined based on qualitative reading using color maps of mean transit time, cerebral blood flow, and cerebral blood volume as criteria. The presence or absence of vasospasm as retrospectively determined using CT perfusion was compared with DS angiography findings. Of the 23 CT perfusion scans performed, 21 (91%) were concordant with angiography findings in predicting the presence or absence of vasospasm. In 15 of 23 scans, the presence of vasospasm was detected on CT perfusion scans and confirmed on DS angiography studies. In two cases, vasospasm was revealed on DS angiography but was not confirmed on CT perfusion. The degree of agreement between CT perfusion and DS angiography for detection of vasospasm was high (κ = 0.8, p < 0.0001). Conclusions Computed tomography perfusion is an accurate, reliable, and noninvasive method to detect the presence or absence of vasospasm. It can be used as a tool to help guide the decision to pursue DS angiography with the intent to treat vasospasm.

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Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm–Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage

World Neurosurgery ◽

10.1016/j.wneu.2018.09.208 ◽

2019 ◽

Vol 121 ◽

pp. e739-e746 ◽

Cited By ~ 3

Author(s):

Sonja Vulcu ◽

Franca Wagner ◽

Ana Fernandes Santos ◽

Ralcua Reitmeir ◽

Nicole Söll ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Computed Tomography Perfusion

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Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Surgical Neurology International ◽

10.25259/sni_14_2020 ◽

2020 ◽

Vol 11 ◽

pp. 233

Author(s):

Koji Omoto ◽

Ichiro Nakagawa ◽

Fumihiko Nishimura ◽

Shuichi Yamada ◽

Yasushi Motoyama ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Clinical Outcomes ◽

Cerebral Vasospasm ◽

Cerebral Blood Volume ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Mean Transit Time ◽

Delayed Cerebral Ischemia ◽

Computed Tomography Perfusion

Background: Endovascular treatment (ET) can improve angiographic cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage, but was unrelated to clinical outcomes in previous analyses. Appropriate detection of CV and precise indications for ET are required. This study investigated whether changes in computed tomography perfusion (CTP) parameter can determine indications for ET in CV and predict its effectiveness. Methods: Participants comprised 140 patients who underwent neck clipping or coil embolization. CTP was performed a week after aneurysmal treatment or when clinical deterioration had occurred. Patients were divided into ET and non-ET groups by propensity score matching. In addition, the ET group was divided into subgroups with and without new cerebral infarction (CI). All CTP images in the three groups were retrospectively investigated qualitatively and quantitatively. CI was diagnosed from CT at 3 months postoperatively. Results: Of the 121 patients examined, 15 patients (11%) needed ET. In qualitative analysis, all ET group patients displayed extension of time-to-peak (TTP) at the region of vasospastic change, regardless of the presence of CI. Quantitative analysis showed significant decreases in cerebral blood volume (P < 0.01), cerebral blood flow (CBF) (P < 0.001), and extension in TTP (P < 0.01) in the ET group compared with the non-ET group. A significant decrease in CBF (P < 0.001) and extension in mean transit time (P < 0.001) was seen in the ET with CI subgroup compared with the ET without CI subgroup. Conclusion: CTP in the vasospastic period may be an indication for ET and predict the effectiveness of ET for CV to improve clinical outcomes.

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Cerebral vasospasm following post-traumatic subarachnoid hemorrhage evaluated by transcranial Doppler ultrasonography

Journal of the Neurological Sciences ◽

10.1016/0022-510x(93)90185-2 ◽

1993 ◽

Vol 119 (1) ◽

pp. 1-7 ◽

Cited By ~ 47

Author(s):

Dirk Sander ◽

Jürgen Klingelhöfer

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Transcranial Doppler ◽

Doppler Ultrasonography ◽

Transcranial Doppler Ultrasonography ◽

Post Traumatic ◽

Traumatic Subarachnoid Hemorrhage

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Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v6i2.50745 ◽

2020 ◽

Vol 6 (2) ◽

pp. 78-81

Author(s):

Md Tauhidul Islam Chowdhury ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Sadekur Rahman Sarkar ◽

KM Ahasan Ahmed ◽

Md Nazmul Kabir ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Computed Tomography Angiography ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Multiple Aneurysm ◽

Traumatic Subarachnoid Hemorrhage ◽

One Year ◽

Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity. Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage. Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study. Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm. Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

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Does 16-Detector Computed Tomography Improve Detection of Non-traumatic Subarachnoid Hemorrhage in the Emergency Department?

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2007.10.066 ◽

2009 ◽

Vol 36 (2) ◽

pp. 171-175 ◽

Cited By ~ 11

Author(s):

Ana P. Lourenco ◽

William W. Mayo-Smith ◽

Robert J. Tubbs ◽

Robert Sidman

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Subarachnoid Hemorrhage ◽

Traumatic Subarachnoid Hemorrhage

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Serial Quantitative Computed Tomography Perfusion in Aneurysmal Subarachnoid Hemorrhage

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.351 ◽

2016 ◽

Vol 43 (3) ◽

pp. 375-380 ◽

Cited By ~ 2

Author(s):

Cheemun Lum ◽

Matthew J. Hogan ◽

John Sinclair ◽

Shane English ◽

Howard Lesiuk ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Middle Cerebral Artery ◽

Transit Time ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Mean Transit Time ◽

Arterial Diameter ◽

Computed Tomography Perfusion

AbstractPurpose: Computed tomography perfusion (CTP) has been performed to predict which patients with aneurysmal subarachnoid hemorrhage are at risk of developing delayed cerebral ischemia (DCI). Patients with severe arterial narrowing may have significant reduction in perfusion. However, many patients have less severe arterial narrowing. There is a paucity of literature evaluating perfusion changes which occur with mild to moderate narrowing. The purpose of our study was to investigate serial whole-brain CTP/computed tomography angiography in aneurysm-related subarachnoid hemorrhage (aSAH) patients with mild to moderate angiographic narrowing. Methods: We retrospectively studied 18 aSAH patients who had baseline and follow-up whole-brain CTP/computed tomography angiography. Thirty-one regions of interest/hemisphere at six levels were grouped by vascular territory. Arterial diameters were measured at the circle of Willis. The correlation between arterial diameter and change in CTP values, change in CTP in with and without DCI, and response to intra-arterial vasodilator therapy in DCI patients was evaluated. Results: There was correlation among the overall average cerebral blood flow (CBF; R=0.49, p<0.04), mean transit time (R=–0.48, p=0.04), and angiographic narrowing. In individual arterial territories, there was correlation between changes in CBF and arterial diameter in the middle cerebral artery (R=0.53, p=0.03), posterior cerebral artery (R=0.5, p=0.03), and anterior cerebral artery (R=0.54, p=0.02) territories. Prolonged mean transit time was correlated with arterial diameter narrowing in the middle cerebral artery territory (R=0.52, p=0.03). Patients with DCI tended to have serial worsening of CBF compared with those without DCI (p=0.055). Conclusions: Our preliminary study demonstrates there is a correlation between mild to moderate angiographic narrowing and serial changes in perfusion in patients with aSAH. Patients developing DCI tended to have progressively worsening CBF compared with those not developing DCI.

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