Vulcu Sonja, Wagner Franca, Santos Ana Fernandes, Reitmeir Ralcua, Söll Nicole, Schöni Daniel, Fung Christian, Wiest Roland, Raabe Andreas, Beck Jürgen, Z'Graggen Werner J
Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
World Neurosurg. 2019 Jan;121:e739-e746. doi: 10.1016/j.wneu.2018.09.208. Epub 2018 Oct 9.
Delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (aSAH) still remains the leading cause of disability in patients that survive the initial ictus. It has been shown that computed tomography perfusion (CTP) imaging can detect hypoperfused brain areas. The aim of this study was to evaluate if a single acute CTP examination at time of neurologic deterioration is sufficient or if an additional baseline CTP increases diagnostic accuracy.
Retrospective analysis of acute and baseline (within 24 hours after aneurysm treatment) CTP examinations of patients with neurologic deterioration because of vasospasm-related hypoperfusion. Patients without clinical deterioration during the vasospasm period served as control subjects. The following CTP parameters were analyzed for predefined brain regions: time to drain (TTD), mean transit time, time to peak, cerebral blood flow, and volume.
Thirty-three patients with and 23 without neurologic deterioration were included. Baseline CTP examination did not ameliorate diagnostic accuracy of the acute CTP examination in symptomatic patients. The same was true for interhemispheric comparison of perfusion parameters of the acute examination. The CTP parameter with the highest diagnostic yield was TTD of the symptomatic brain region (threshold value, 4.7 seconds; sensitivity, 97%; specificity, 96%).
Acute CTP examination in case of suspected vasospasm-induced neurologic deterioration after aSAH has the highest diagnostic accuracy to detect misery perfusion. Additional baseline CTP is not needed. The most sensitive parameter to detect critically perfused brain areas is TTD.
动脉瘤性蛛网膜下腔出血（aSAH）后的迟发性脑梗死仍然是急性期存活患者致残的主要原因。研究表明，计算机断层扫描灌注（CTP）成像能够检测脑灌注不足区域。本研究旨在评估在神经功能恶化时进行单次急性CTP检查是否足够，或者额外的基线CTP检查是否能提高诊断准确性。
对因血管痉挛相关灌注不足导致神经功能恶化的患者的急性和基线（动脉瘤治疗后24小时内）CTP检查进行回顾性分析。血管痉挛期无临床恶化的患者作为对照。对预定义脑区分析以下CTP参数：引流时间（TTD）、平均通过时间、达峰时间、脑血流量和血容量。
纳入33例有神经功能恶化的患者和23例无神经功能恶化的患者。基线CTP检查并未提高有症状患者急性CTP检查的诊断准确性。急性检查灌注参数的半球间比较情况相同。诊断价值最高的CTP参数是有症状脑区的TTD（阈值为4.7秒；灵敏度为97%；特异度为96%）。
对于aSAH后疑似血管痉挛引起的神经功能恶化，急性CTP检查在检测灌注不良方面具有最高的诊断准确性。不需要额外的基线CTP检查。检测严重灌注不足脑区最敏感的参数是TTD。
