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超声灌注成像在蛛网膜下腔出血后脑灌注不足检测中的应用。

Ultrasound Perfusion Imaging for the Detection of Cerebral Hypoperfusion After Aneurysmal Subarachnoid Hemorrhage.

机构信息

Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany.

Medical Faculty, University of Freiburg, Freiburg, Germany.

出版信息

Neurocrit Care. 2022 Aug;37(1):149-159. doi: 10.1007/s12028-022-01460-z. Epub 2022 Feb 24.

DOI:10.1007/s12028-022-01460-z
PMID:35211837
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9283360/
Abstract

BACKGROUND

Delayed cerebral ischemia increases mortality and morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Various techniques are applied to detect cerebral vasospasm and hypoperfusion. Contrast-enhanced ultrasound perfusion imaging (UPI) is able to detect cerebral hypoperfusion in acute ischemic stroke. This prospective study aimed to evaluate the use of UPI to enable detection of cerebral hypoperfusion after aSAH.

METHODS

We prospectively enrolled patients with aSAH and performed UPI examinations every second day after aneurysm closure. Perfusion of the basal ganglia was outlined to normalize the perfusion records of the anterior and posterior middle cerebral artery territory. We applied various models to characterize longitudinal perfusion alterations in patients with delayed ischemic neurologic deficit (DIND) across the cohort and predict DIND by using a multilayer classification model.

RESULTS

Between August 2013 and December 2015, we included 30 patients into this prospective study. The left-right difference of time to peak (TTP) values showed a significant increase at day 10-12. Patients with DIND demonstrated a significant, 4.86 times increase of the left-right TTP ratio compared with a mean fold change in patients without DIND of 0.9 times (p = 0.032).

CONCLUSIONS

UPI is feasible to enable detection of cerebral tissue hypoperfusion after aSAH, and the left-right difference of TTP values is the most indicative result of this finding.

摘要

背景

迟发性脑缺血会增加颅内动脉瘤性蛛网膜下腔出血（aSAH）患者的死亡率和病残率。目前有多种技术可用于检测脑血管痉挛和低灌注。对比增强超声灌注成像（UPI）能够检测急性缺血性卒中的脑低灌注。本前瞻性研究旨在评估 UPI 在检测 aSAH 后脑低灌注中的应用。

方法

我们前瞻性地纳入了 aSAH 患者，并在动脉瘤夹闭后每两天进行一次 UPI 检查。对基底节进行灌注描记，以对前、中大脑动脉区域的灌注记录进行标准化。我们应用各种模型来描述跨队列出现迟发性缺血性神经功能缺损（DIND）患者的纵向灌注改变，并使用多层分类模型预测 DIND。

结果

在 2013 年 8 月至 2015 年 12 月期间，我们前瞻性地纳入了 30 例患者。在第 10-12 天，达峰时间（TTP）的左右差异值明显增加。与无脑 DIND 患者的平均折叠变化（0.9 倍）相比，DIND 患者的左右 TTP 比值显著增加了 4.86 倍（p=0.032）。

结论

UPI 可用于检测 aSAH 后的脑组织低灌注，TTP 值的左右差异是该发现最具指示性的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/8d213d31fc2d/12028_2022_1460_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/35d602ae7249/12028_2022_1460_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/2b32df85a1bb/12028_2022_1460_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/d245bf6584a3/12028_2022_1460_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/0e0bd0a8fddb/12028_2022_1460_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/0155c4b25553/12028_2022_1460_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/d055a04f9f36/12028_2022_1460_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/300833f6d1b8/12028_2022_1460_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/8d213d31fc2d/12028_2022_1460_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/35d602ae7249/12028_2022_1460_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/2b32df85a1bb/12028_2022_1460_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/d245bf6584a3/12028_2022_1460_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/0e0bd0a8fddb/12028_2022_1460_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/0155c4b25553/12028_2022_1460_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/d055a04f9f36/12028_2022_1460_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/300833f6d1b8/12028_2022_1460_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/793a/9283360/8d213d31fc2d/12028_2022_1460_Fig8_HTML.jpg

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