Nakagawa Manabu, Mutoh Tatsushi, Takenaka Shunsuke, Mutoh Tomoko, Totsune Tomoko, Taki Yasuyuki, Ishikawa Tatsuya
Department of Radiology, Ohara General Hospital, Fukushima, Japan.
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.
Med Sci Monit. 2017 Jan 17;23:285-291. doi: 10.12659/msm.899985.
BACKGROUND Delayed cerebral ischemia (DCI) is one of the main causes of poor outcomes after subarachnoid hemorrhage (SAH). The early identification of DCI by noninvasive imaging modalities would provide valuable information of therapeutic intervention for improving the patient outcomes. We aimed to describe the clinical features of cerebral blood flow (CBF) data obtained from the single-photon emission computed tomography (SPECT) during the risk period for DCI after SAH. MATERIAL AND METHODS Clinical data from 94 SAH patients who underwent surgical clipping of anterior circulation aneurysms were reviewed retrospectively. 99mTc-HMPAO SPECT images were visually and semiquantitatively analyzed on days 7 and 14 after SAH. RESULTS In all cases, the areas of hypoperfusion were found in the middle cerebral artery territories. By contrast, the areas of mild hyperperfusion were always detected on the surgical side, the prevalence which increased from days 7 (n=28; 30%) to 14 (n=48; 51%) without neurological defects. Univariate analysis revealed that the hyperperfusion on day 14 had a significant relationship with functional outcome at 3 months (P=0.04). Multivariate analysis including age, clinical SAH grade, DCI, and hyperperfusion on day 14 showed that DCI (P=0.004; odds ratio [OR], 0.10; 95% confidence interval [CI], 0.02-0.48) and hyperperfusion on day 14 (P=0.002; OR, 2.44; 95% CI, 1.40-4.29) were independently associated with functional outcome at 3 months. CONCLUSIONS Delayed mild hyperperfusion around the surgical site can predict good prognosis after SAH, although it may hinder the CBF diagnosis of focal ischemia attributable to DCI.
背景 迟发性脑缺血（DCI）是蛛网膜下腔出血（SAH）后预后不良的主要原因之一。通过无创成像方式早期识别DCI将为改善患者预后的治疗干预提供有价值的信息。我们旨在描述SAH后DCI风险期内从单光子发射计算机断层扫描（SPECT）获得的脑血流量（CBF）数据的临床特征。
材料与方法 回顾性分析94例行前循环动脉瘤手术夹闭的SAH患者的临床资料。在SAH后第7天和第14天对99mTc-HMPAO SPECT图像进行视觉和半定量分析。
结果 在所有病例中，均发现大脑中动脉供血区存在灌注不足区域。相比之下，手术侧总是检测到轻度高灌注区域，其发生率从第7天的28例（30%）增加到第14天的48例（51%），且无神经功能缺损。单因素分析显示，第14天的高灌注与3个月时的功能结局有显著相关性（P = 0.04）。包括年龄、临床SAH分级、DCI和第14天的高灌注在内的多因素分析表明，DCI（P = 0.004；比值比[OR]，0.10；95%置信区间[CI]，0.02 - 0.48）和第14天的高灌注（P = 0.002；OR，2.44；95% CI，1.40 - 4.29）与3个月时的功能结局独立相关。
结论 手术部位周围迟发性轻度高灌注可预测SAH后的良好预后，尽管它可能会妨碍对DCI所致局灶性缺血的CBF诊断。
