Prolonged Cerebral Circulation Time Is the Best Parameter for Predicting Vasospasm during Initial CT Perfusion in Subarachnoid Hemorrhagic Patients

Abstract

PurposeWe sought to imitate angiographic cerebral circulation time (CCT) and create a similar index from baseline CT perfusion (CTP) to better predict vasospasm in patients with subarachnoid hemorrhage (SAH).MethodsForty-one SAH patients with available DSA and CTP were retrospectively included. The vasospasm group was comprised of patients with deterioration in conscious functioning and newly developed luminal narrowing; remaining cases were classified as the control group. The angiography CCT (XA-CCT) was defined as the difference in TTP (time to peak) between the selected arterial ROIs and the superior sagittal sinus (SSS). Four arterial ROIs were selected to generate four corresponding XA-CCTs: the right and left anterior cerebral arteries (XA-CCTRA2 and XA-CCTLA2) and right- and left-middle cerebral arteries (XA-CCTRM2 and XA-CCTLM2). The CCTs from CTP (CT-CCT) were defined as the differences in TTP from the corresponding arterial ROIs and the SSS. Correlations of the different CCTs were calculated and diagnostic accuracy in predicting vasospasm was evaluated.ResultsIntra-class correlations ranged from 0.96 to 0.98. The correlations of XA-CCTRA2, XA-CCTRM2, XA-CCTLA2, and XA-CCTLM2 with the corresponding CT-CCTs were 0.64, 0.65, 0.53, and 0.68, respectively. All CCTs were significantly prolonged in the vasospasm group (5.8–6.4 s) except for XA-CCTLA2. CT-CCTA2 of 5.62 was the optimal cut-off value for detecting vasospasm with a sensitivity of 84.2% and specificity 82.4%ConclusionCT-CCTs can be used to interpret cerebral flow without deconvolution algorithms, and outperform both MTT and TTP in predicting vasospasm risk. This finding may help facilitate management of patients with SAH.

Automated Grading of Cerebral Vasospasm to Standardize Computed Tomography Angiography Examinations After Subarachnoid Hemorrhage

“…Thirdly, the combination of the automated detection of vasospasm on CTA and cerebral hypoperfusion on CTP was superior to assessments by either CTP or CTA alone for identifying patients with impeding cerebral infarction who underwent interventional DSA for vasospasm treatment to prevent this within 24 h. It remains difficult to identify the patients who would benefit from endovascular treatment of vasospasm. CTP has been shown to have good sensitivity and specificity for predicting angiographic vasospasm or cerebral infarction in SAH patients during the course of the disease (13)(14)(15)(16)(17)(18); however, a prospective study reported that CTP had a PPV of only 29% for predicting severe vasospasm or a new cerebral infarction within the subsequent 72 h (19). Another study reported that a combination of vasospasm identified by CTA together with an increased mean transit time on CTP was the most accurate method for predicting vasospasm as identified by DSA (20).…”

“…Therefore, in many clinical centers (including ours), the decision on whether or not to perform endovascular vasospasm treatment is based on the clinical symptoms, combined with CTP to detect cerebral hypoperfusion and CTA to estimate the extent of angiographic vasospasm. However, while the CTP evaluation is based on rather objective parameters and scores (13)(14)(15)(16)(17)(18)(19), there is a lack of corresponding objective parameters for the evaluation of CTA, resulting in a considerable degree of subjectivity and investigator dependence.…”

“…Studies have shown that CTP can be used to detect cerebral hypoperfusion and predict cerebral infarction (13)(14)(15)(16)(17)(18). A prospective observational study, however, reported that CTP had a positive predictive value (PPV) of only 29% for forecasting severe vasospasm or new cerebral infarction within the subsequent 72 h (19).…”

“…Therefore, CTA is commonly regarded as offering a valuable adjunct to CTP for deciding whether DSA and endovascular intervention are indicated. However, although several studies have established objective scores and defined thresholds for the evaluation of CTP (13)(14)(15)(16)(17)(18)(19), there remains a lack of objective parameters or thresholds for the interpretation of CTA.…”

Machine Learning Application With Quantitative Digital Subtraction Angiography for Detection of Hemorrhagic Brain Arteriovenous Malformations

“…BAT, TTP, WO, FWHM, and AUCTDC were reduced in patients with carotid stenosis after stenting [7], indicating increased flow through the carotid artery after treatment. Additionally, TTP has been used to estimate the cerebral circulation time for the detection of vasospasms in patients with subarachnoid hemorrhages [26]. A double peak sign of the TDC was observed in dural arteriovenous fistula and is used for the evaluation of venous drainage function [6].…”