Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 1 Swan Lake Road, Hefei, Anhui Province, 230001, PR China.
Medical Imaging Center, The First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan west Road, Wuhu, Anhui Province, 241001, PR China.
Eur J Radiol. 2019 Jul;116:165-173. doi: 10.1016/j.ejrad.2019.05.008. Epub 2019 May 8.
The aim of this study is to prospectively evaluate whole-brain CT perfusion (CTP) on admission to predict delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).
All 252 consecutive patients with aSAH enrolled in this study underwent one-stop whole-brain CTP scan within 24 h after aneurysm rupture. The qualitative and quantitative CTP parameters and clinical data were compared between patients with and without DCI. Diagnostic performance of clinical data and mean and lowest CTP parameters were evaluated by receiver-operating characteristic (ROC) analyses. Logistic regression analysis was employed to determine predictors of DCI.
The study evaluated 191 of 252 consecutive patients, 57 of whom (29.8%) developed DCI during hospitalization. Patients with diffused hypoperfusion had the highest incidence rate of DCI (43%, 46/107). Mean TMax produced the largest area under the curve of 0.726 (95% confidence interval [CI] 0.638-0.814), and a cutoff value of 2.240 s provided sensitivity of 73.7% and specificity of 71.6% for early prediction of developing DCI. Glasgow Coma Scale score (odds ratio [OR] = 0.716, 95% CI 0.565-0.908, P = 0.006), cerebral vasospasm (OR = 6.117, 95% CI 1.427-26.223, P = 0.015), hydrocephalus (OR = 3.795, 95% CI 1.327-10.858, P = 0.013), and qualitative CTP analysis (OR = 3.383, 95% CI 1.686-6.789, P = 0.001) were all significant independent predictors of DCI.
Whole-brain CTP within 24 h of admission can qualitatively and quantitatively detect abnormal cerebral perfusion. It is possible to predict the risk of developing DCI after aSAH when the TMax value is larger than 2.240 s.
本研究旨在前瞻性评估全脑 CT 灌注（CTP）在入院时对预测颅内迟发性脑缺血（DCI）的作用，以评估颅内动脉瘤性蛛网膜下腔出血（aSAH）患者的全脑 CTP。
本研究共纳入 252 例连续的 aSAH 患者，所有患者均在动脉瘤破裂后 24 小时内行一站式全脑 CTP 扫描。比较 DCI 组与非 DCI 组患者的 CTP 定性和定量参数以及临床资料。通过受试者工作特征（ROC）分析评估临床资料、平均和最低 CTP 参数的诊断性能。采用 logistic 回归分析确定 DCI 的预测因素。
本研究共评估了 252 例连续患者中的 191 例，其中 57 例（29.8%）在住院期间发生 DCI。弥散性低灌注患者的 DCI 发生率最高（43%，46/107）。TMax 平均值的曲线下面积最大，为 0.726（95%置信区间[CI]：0.638-0.814），截断值为 2.240s 时，对 DCI 发生的早期预测具有 73.7%的敏感性和 71.6%的特异性。格拉斯哥昏迷量表评分（比值比[OR] = 0.716，95%CI：0.565-0.908，P = 0.006）、脑血管痉挛（OR = 6.117，95%CI：1.427-26.223，P = 0.015）、脑积水（OR = 3.795，95%CI：1.327-10.858，P = 0.013）和 CTP 定性分析（OR = 3.383，95%CI：1.686-6.789，P = 0.001）均为 DCI 的独立显著预测因素。
入院 24 小时内行全脑 CTP 可定性和定量检测异常脑灌注。当 TMax 值大于 2.240s 时，可预测 aSAH 后发生 DCI 的风险。
