CT Perfusion-Derived Mean Transit Time Predicts Early Mortality and Delayed Vasospasm after Experimental Subarachnoid Hemorrhage

Laslo, A.M.; Eastwood, James D.; Pakkiri, Pria; Chen, F.; Lee, T.Y.

doi:10.3174/ajnr.a0747

Cited by 50 publications

(18 citation statements)

References 36 publications

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“…Early studies examining angiographic cerebral circulation time (CCT), generally defined as the time it takes for contrast to flow from the supraclinoid internal carotid artery to maximally concentrate in the parietal cortical veins, showed that CCT was prolonged on initial presentation in patients who developed vasospasm [25]. More recently, Laslo et al studied early changes in cerebral perfusion in a rabbit model and found that MTT prolongation on day 2 predicted the development of moderate/severe vasospasm [26]. Our study supports these findings that alterations in MTT can be detected during the baseline period in A-SAH patients who later develop vasospasm during their hospital course (Fig.…”

Section: Discussionmentioning

confidence: 99%

Using CT perfusion during the early baseline period in aneurysmal subarachnoid hemorrhage to assess for development of vasospasm

et al. 2010

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Introduction The aim of this study is to evaluate computed tomography perfusion (CTP) during admission baseline period (days 0–3) in aneurysmal subarachnoid hemorrhage (A-SAH) for development of vasospasm. Methods Retrospective analysis was performed on A-SAH patients from Dec 2004 to Feb 2007 with CTP on days 0–3. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were analyzed for qualitative perfusion deficits. Quantitative analysis was performed using region-of-interest placement to obtain mean CTP values. Development of vasospasm was determined by a multistage hierarchical reference standard incorporating both imaging and clinical criteria. Student's t test and threshold analysis were performed. Results Seventy-five patients were included, 37% (28/75) were classified as vasospasm. Mean CTP values in vaso-spasm compared to no vasospasm groups were: CBF 31.90 ml/100 g/min vs. 39.88 ml/100 g/min (P<0.05), MTT 7.12 s vs. 5.03 s (P<0.01), and CBV 1.86 ml/100 g vs. 2.02 ml/100 g (P=0.058). Fifteen patients had qualitative perfusion deficits with 73% (11/15) developed vasospasm. Optimal threshold for CBF is 24–25 mL/100 g/min with 91% specificity and 50% sensitivity, MTT is 5.5 s with 70% specificity and 61% sensitivity and CBV is 1.7 mL/ 100 g with 89% specificity and 36% sensitivity. Conclusion These initial results support our hypothesis that A-SAH patients who develop vasospasm may demonstrate early alterations in cerebral perfusion, with statistically significant CBF reduction and MTT prolongation. Overall, CTP has high specificity for development of vasospasm. Future clinical implications include using CTP during the baseline period for early identification of A-SAH patients at high risk for vasospasm to prompt robust preventative measures and treatment.

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Section: Discussionmentioning

confidence: 99%

Using CT perfusion during the early baseline period in aneurysmal subarachnoid hemorrhage to assess for development of vasospasm

et al. 2010

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“…13) The prolongation of the cerebral circulation time (CCT) on digital subtraction arteriography (DSA) has also been reported to reflect increased ICP and to be related to the prognosis. 30) It appears that, in occlusive cerebrovascular disease, the cerebral perfusion pressure decreases, the CBV increases due to compensatory dilatation of the cerebral blood vessels, and the MTT is prolonged.…”

Section: Discussionmentioning

confidence: 99%

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Honda

Sase

Yokota

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR] ). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.

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“…Previous human and animal models demonstrated that vasospasm-induced circulatory changes mainly result from impairment of endothelial relaxation, which is already observed in the first days after ictus [34,35]. Furthermore, it was shown that MTT changes within the first 2 days after SAH ictus are predictive for early mortality and development of DCI in the rabbit model [36], which was also attributed to early spasm. A possible mechanism for this coherence might be found in a recently reported direct relationship between the duration of the initial drop in cerebral blood flow associated with the initial subarachnoid bleeding and a subsequent activation of contractile function as well as a delayed upregulation of vasoconstrictive receptors in cerebral arteries in experimental SAH [37].…”

Section: Discussionmentioning

confidence: 85%

Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage

et al. 2015

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CT Perfusion-Derived Mean Transit Time Predicts Early Mortality and Delayed Vasospasm after Experimental Subarachnoid Hemorrhage

Cited by 50 publications

References 36 publications

Using CT perfusion during the early baseline period in aneurysmal subarachnoid hemorrhage to assess for development of vasospasm

Using CT perfusion during the early baseline period in aneurysmal subarachnoid hemorrhage to assess for development of vasospasm

Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

Timing of Mean Transit Time Maximization is Associated with Neurological Outcome After Subarachnoid Hemorrhage

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