早期定量CT灌注参数变化对动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测作用
Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage.
作者信息
Rodriguez-Régent Christine, Hafsa Monia, Turc Guillaume, Ben Hassen Wagih, Edjlali Myriam, Sermet Alain, Laquay Nathalie, Trystram Denis, Al-Shareef Fawaz, Meder Jean-Francois, Devaux Bertrand, Oppenheim Catherine, Naggara Olivier
机构信息
Departments of Neuroradiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR894, 1 rue Cabanis, 75014, Paris, France.
Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM U894, Paris, France.
出版信息
Eur Radiol. 2016 Sep;26(9):2956-63. doi: 10.1007/s00330-015-4135-z. Epub 2015 Dec 16.
OBJECTIVES
To prospectively evaluate the predictive value of cerebral perfusion-computerized tomography (CTP) parameters variation between day0 and day4 after aneurysmal subarachnoid haemorrhage (aSAH).
METHODS
Mean transit time (MTT) and cerebral blood flow (CBF) values were compared between patients with delayed cerebral ischemia (DCI+ group) and patients without DCI (DCI- group) for previously published optimal cutoff values and for variations of MTT (ΔMTT) and of CBF (ΔCBF) values between day0 and day4. DCI+ was defined as a cerebral infarction on 3-months follow-up MRI.
RESULTS
Among 47 included patients, 10 suffered DCI+. Published optimal cutoff values did not predict DCI, either at day0 or at day4. Conversely, ΔMTT and ΔCBF significantly differed between the DCI+ and DCI- groups, with optimal ΔMTT and ΔCBF values of 0.91 seconds (83.9 % sensitivity, 79.5 % specificity, AUC 0.84) and -7.6 mL/100 g/min (100 % sensitivity, 71.4 % specificity, AUC 0.86), respectively. In multivariate analysis, ΔCBF (OR = 1.91, IC95% 1.13-3.23 per each 20 % decrease of ΔCBF) and ΔMTT values (OR = 14.70, IC95% 4.85-44.52 per each 20 % increase of ΔMTT) were independent predictors of DCI.
CONCLUSIONS
Assessment of MTT and CBF value variations between day0 and day4 may serve as an early imaging surrogate for prediction of DCI in aSAH.
KEY POINTS
• CT perfusion values are an imaging surrogate for prediction of DCI. • Early variations (day0-day4) after aneurysmal subarachnoid haemorrhage predicted DCI. • A CBF decrease of 7.6 mL/min/100 g predicted DCI with 100 % sensitivity. • An MTT increase of 0.91 seconds predicted DCI with 83.9 % sensitivity. • DCI risk multiplied by 2 per 20 % ΔCBF decrease and by 15 per 20 % ΔMTT increase.
目的
前瞻性评估动脉瘤性蛛网膜下腔出血（aSAH）后第0天和第4天之间脑灌注计算机断层扫描（CTP）参数变化的预测价值。
方法
比较延迟性脑缺血患者（DCI+组）和无DCI患者（DCI-组）之间的平均通过时间（MTT）和脑血流量（CBF）值，以确定先前公布的最佳临界值以及第0天和第4天之间MTT（ΔMTT）和CBF（ΔCBF）值的变化。DCI+定义为3个月随访MRI显示的脑梗死。
结果
在纳入的47例患者中，10例发生DCI+。公布的最佳临界值在第0天或第4天都不能预测DCI。相反，DCI+组和DCI-组之间的ΔMTT和ΔCBF有显著差异，最佳ΔMTT和ΔCBF值分别为0.91秒（灵敏度83.9%，特异度79.5%，AUC 0.84）和-7.6 mL/100 g/min（灵敏度100%，特异度71.4%，AUC 0.86）。在多变量分析中，ΔCBF（OR = 1.91，每20%的ΔCBF降低，IC95%为1.13 - 3.23）和ΔMTT值（OR = 14.70，每20%的ΔMTT增加，IC95%为4.85 - 44.52）是DCI的独立预测因素。
结论
评估第0天和第4天之间的MTT和CBF值变化可作为aSAH中预测DCI的早期影像学替代指标。
要点
•CT灌注值是预测DCI 的影像学替代指标。•动脉瘤性蛛网膜下腔出血后的早期变化（第0天至第4天）可预测DCI。•CBF降低7.6 mL/min/100 g可100%敏感地预测DCI。•MTT增加0.91秒可83.9%敏感地预测DCI。•每20%的ΔCBF降低，DCI风险增加2倍；每20%的ΔMTT增加，DCI风险增加15倍。
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