Department of Clinical Neurosciences, Service of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Department of Clinical Neurosciences, Service of Neurosurgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
World Neurosurg. 2019 Oct;130:e743-e752. doi: 10.1016/j.wneu.2019.06.213. Epub 2019 Jul 5.
We investigated the ability of early alteration of cerebral perfusion-computed tomography (PCT) parameters to predict the risk of vasospasm, delayed cerebral ischemia (DCI), and clinical outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).
A retrospective cohort study of 38 aSAH patients investigated with PCT within 48 hours after hemorrhage. Cerebral blood flow (CBF), cerebral blood volume, and mean transit time (MTT) values were recorded. Mean values were compared with clinical data. Vasospasm and DCI were determined by imaging and clinical criteria. Neurologic outcome was assessed by the modified Rankin Scale at discharge and 1-year follow-up visit.
More than a third (39.5%) of patients developed DCI, of whom 86.7% presented moderate-severe vasospasm. There was a significant correlation between perfusion parameters in the early phase and occurrence of DCI and vasospasm. The occurrence of DCI and vasospasm correlated significantly with lower mean early PCT values. DCI was correlated with lower mean early CBF values (P = 0.049) and vasospasm with lower mean CBF (P = 0.01) and MTT (P < 0.00001) values. MTT values of 5.5s were shown to have 94% specificity and 100% sensitivity for predicting the risk of developing vasospasm. The severity of the SAH according to the Barrow Neurological Institute scale correlated significantly with the risk of developing DCI and vasospasm, both significantly associated with unfavorable neurologic outcome (modified Rankin Scale score 3-6) (P = 0.0002 and P = 0.02, respectively).
Early alterations in PCT parameters and high Barrow Neurological Institute grade may identify a subgroup of patients at high risk of developing DCI and vasospasm after aSAH, thus prompting more robust preventative measures and treatment in this subgroup.
我们研究了脑灌注计算机断层扫描（PCT）参数早期改变预测动脉瘤性蛛网膜下腔出血（aSAH）患者血管痉挛、迟发性脑缺血（DCI）和临床预后风险的能力。
回顾性队列研究了 38 例 aSAH 患者，在出血后 48 小时内进行了 PCT 检查。记录脑血流量（CBF）、脑血容量和平均通过时间（MTT）值。将平均值与临床数据进行比较。血管痉挛和 DCI 通过影像学和临床标准确定。神经功能预后在出院和 1 年随访时通过改良 Rankin 量表评估。
超过三分之一（39.5%）的患者发生了 DCI，其中 86.7%表现为中重度血管痉挛。灌注参数在早期与 DCI 和血管痉挛的发生有显著相关性。DCI 的发生与早期 PCT 值较低有显著相关性，血管痉挛与早期 CBF 值较低（P=0.049）和 MTT 值较低（P<0.00001）有显著相关性。MTT 值为 5.5s 时，对预测发生血管痉挛的风险具有 94%的特异性和 100%的敏感性。根据巴罗神经学研究所（Barrow Neurological Institute）分级，蛛网膜下腔出血的严重程度与发生 DCI 和血管痉挛的风险显著相关，这两种情况均与不良神经预后（改良 Rankin 量表评分 3-6）显著相关（P=0.0002 和 P=0.02）。
PCT 参数的早期改变和较高的巴罗神经学研究所分级可能确定了 aSAH 后发生 DCI 和血管痉挛风险较高的患者亚组，从而在该亚组中更积极地采取预防措施和治疗。
