National Center for Neurosurgery, Beaumont Hospital, Dublin 9, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Acta Neurochir (Wien). 2021 May;163(5):1457-1467. doi: 10.1007/s00701-020-04670-6. Epub 2021 Jan 6.
Aneurysmal subarachnoid haemorrhage is associated with significant morbidity and mortality due to the myriad of complications contributing to early brain injury and delayed cerebral ischaemia. There is increasing interest in the exploration of the association between blood-brain barrier integrity and risks of delayed cerebral ischaemia and poor outcomes. Despite recent advances in cerebral imaging, radiographic imaging of blood-brain barrier disruption, as a biomarker for outcome prediction, has not been adopted in clinical practice.
We performed a narrative review by searching for articles describing molecular changes or radiological identification of changes in BBB permeability following subarachnoid haemorrhage (SAH) on MEDLINE. Preclinical studies were analysed if reported structural changes and clinical studies were included if they investigated for radiological markers of BBB disruption and its correlation with delayed cerebral ischaemia.
There is ample preclinical evidence to suggest that there are structural changes in BBB permeability following SAH. The available clinical literature has demonstrated correlations between permeability imaging and outcomes following aneurysmal subarachnoid haemorrhage (aSAH).
Radiological biomarkers offer a potential non-invasive prognostication tool and may also allow early identifications of patients who may be at risk of DCI.
由于多种并发症导致早期脑损伤和迟发性脑缺血，蛛网膜下腔出血与显著的发病率和死亡率相关。人们越来越关注血脑屏障完整性与迟发性脑缺血和不良预后风险之间的关系。尽管在脑成像方面取得了新进展，但作为预后预测生物标志物的血脑屏障破坏的放射性成像尚未在临床实践中得到应用。
我们通过在 MEDLINE 上搜索描述蛛网膜下腔出血（SAH）后血脑屏障通透性分子变化或放射学识别变化的文章，进行了叙述性综述。如果报告了结构变化，则对临床前研究进行了分析，如果研究了 BBB 破坏的放射学标志物及其与迟发性脑缺血的相关性，则纳入临床研究。
有大量临床前证据表明，SAH 后 BBB 通透性存在结构变化。现有的临床文献表明，通透性成像与动脉瘤性蛛网膜下腔出血（aSAH）后的结果之间存在相关性。
放射学生物标志物提供了一种有潜力的非侵入性预后预测工具，并且还可能早期识别出有发生 DCI 风险的患者。
