Neulen Axel, Kunzelmann Svenja, Kosterhon Michael, Pantel Tobias, Stein Maximilian, Berres Manfred, Ringel Florian, Brockmann Marc A, Brockmann Carolin, Kantelhardt Sven R
Department of Neurosurgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany.
Front Neurol. 2020 Jan 30;11:13. doi: 10.3389/fneur.2020.00013. eCollection 2020.
Computed tomography angiography (CTA) is frequently used with computed tomography perfusion imaging (CTP) to evaluate whether endovascular vasospasm treatment is indicated for subarachnoid hemorrhage patients with delayed cerebral ischemia. However, objective parameters for CTA evaluation are lacking. In this study, we used an automated, investigator-independent, digital method to detect vasospasm, and we evaluated whether the method could predict the need for subsequent endovascular vasospasm treatment. We retrospectively reviewed the charts and analyzed imaging data for 40 consecutive patients with subarachnoid hemorrhages. The cerebrovascular trees were digitally reconstructed from CTA data, and vessel volume and the length of the arteries of the circle of Willis and their peripheral branches were determined. Receiver operating characteristic curve analysis based on a comparison with digital subtraction angiographies was used to determine volumetric thresholds that indicated severe vasospasm for each vessel segment. The automated threshold-based volumetric evaluation of CTA data was able to detect severe vasospasm with high sensitivity and negative predictive value for predicting cerebral hypoperfusion on CTP, although the specificity and positive predictive value were low. Combining the automated detection of vasospasm on CTA and cerebral hypoperfusion on CTP was superior to CTP or CTA alone in predicting endovascular vasospasm treatment within 24 h after the examination. This digital volumetric analysis of the cerebrovascular tree allowed the objective, investigator-independent detection and quantification of vasospasms. This method could be used to standardize diagnostics and the selection of subarachnoid hemorrhage patients with delayed cerebral ischemia for endovascular diagnostics and possible interventions.
计算机断层血管造影（CTA）常与计算机断层灌注成像（CTP）联合使用，以评估对于伴有延迟性脑缺血的蛛网膜下腔出血患者是否需要进行血管内血管痉挛治疗。然而，CTA评估缺乏客观参数。在本研究中，我们使用一种自动化、独立于研究者的数字方法来检测血管痉挛，并评估该方法是否能够预测后续血管内血管痉挛治疗的必要性。我们回顾性分析了40例连续蛛网膜下腔出血患者的病历并分析了其影像数据。从CTA数据中对脑血管树进行数字重建，并确定血管体积以及 Willis 环及其外周分支动脉的长度。基于与数字减影血管造影的比较进行受试者操作特征曲线分析，以确定每个血管段提示严重血管痉挛的体积阈值。基于阈值的CTA数据自动化体积评估能够以高灵敏度和阴性预测值检测到严重血管痉挛，从而预测CTP上的脑灌注不足，尽管特异性和阳性预测值较低。在预测检查后24小时内的血管内血管痉挛治疗方面，将CTA上血管痉挛的自动检测与CTP上的脑灌注不足相结合优于单独使用CTP或CTA。这种对脑血管树的数字体积分析能够客观、独立于研究者地检测和量化血管痉挛。该方法可用于标准化诊断以及选择适合进行血管内诊断和可能干预的伴有延迟性脑缺血的蛛网膜下腔出血患者。
