Szabo Vivien, Mesnildrey Quentin, Dargazanli Cyril, Kucharczak Florentin, Kobbai Alexandre, Perrigault Pierre-François, Chalard Kévin
Department of Critical Care Medicine and Anesthesiology, Gui de Chauliac University Hospital of Montpellier, Montpellier, France.
IGF, Univ. Montpellier, CNRS, Inserm, Montpellier, France.
J Cereb Blood Flow Metab. 2025 Aug 5:271678X251361254. doi: 10.1177/0271678X251361254.
Preclinical and clinical studies suggest an early and progressive deterioration in cerebral perfusion leading to delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). Computed Tomography Perfusion (CTP) has then been investigated for DCI diagnosis and prognosis. However, spatial and temporal evolution of CTP-derived metrics have not been established, such that optimal CTP periodicity for monitoring and metrics thresholds for triggering intervention remain unclear. We developed an image processing pipeline to quantify CTP parameters' dynamics in SAH patients. Sixty-two patients were retrospectively included. Cerebral vasospasm (CVS) occurrence was 68%, that of DCI 15%. CTP parameters displayed specific dynamics in each of the noCVS, , and groups. In the category, showed early hyperemia and global flow homogenization, followed by an increased mean and variability of . These features were included in a DCI predictive model (AUC = 0.94 after bootstrapping correction). Two types of dynamics emerged in DCI patients, one characterized by high asymmetry between hemispheric parameters, the other by a rapid whole-brain deterioration of brain perfusion. In conclusion, CTP parameters' early dynamics allow to sort SAH patients that will develop either CVS or DCI, advocating for repeating CTP examinations to adapt therapeutic strategies.
临床前和临床研究表明，动脉瘤性蛛网膜下腔出血（SAH）后，脑灌注会早期且逐渐恶化，导致迟发性脑缺血（DCI）。于是，计算机断层扫描灌注成像（CTP）被用于DCI的诊断和预后评估。然而，基于CTP的指标在空间和时间上的演变尚未明确，因此，用于监测的最佳CTP检查周期以及触发干预的指标阈值仍不清楚。我们开发了一种图像处理流程，以量化SAH患者CTP参数的动态变化。本研究回顾性纳入了62例患者。脑血管痉挛（CVS）的发生率为68%，DCI的发生率为15%。CTP参数在无CVS组、CVS组和DCI组中均表现出特定的动态变化。在CVS组中，表现为早期充血和整体血流均匀化，随后平均通过时间增加且变异性增大。这些特征被纳入一个DCI预测模型（自抽样校正后AUC = 0.94）。DCI患者出现了两种动态变化类型，一种表现为半球参数之间高度不对称，另一种表现为全脑灌注迅速恶化。总之，CTP参数的早期动态变化有助于对将发生CVS或DCI的SAH患者进行分类，提倡重复进行CTP检查以调整治疗策略。
