The Value of Perfusion Computed Tomography (PCT) Imaging After Aneurysmal Subarachnoid Hemorrhage: A Review of the Current Data

Beseoglu, Kerim; Etminan, Nima; Hänggi, Daniel

doi:10.1007/978-3-319-04981-6_6

Cited by 12 publications

(17 citation statements)

References 20 publications

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“…A limitation of the present method presented here is that it can only be used to quantify vasospasm of cerebral vessels, but does not allow conclusions concerning other factors leading to DCI. More pathophysiological information could be provided in future experimental studies by in vivo micro-CTP and in vivo micro-CTA in murine and other rodent models of SAH, as CTP is well established in this context in clinical practice [ 27 – 30 ]. A recent study performed in vivo high resolution digital subtraction angiography [ 31 ] and cerebral CTA of the murine cerebrovasculature [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

A segmentation-based volumetric approach to localize and quantify cerebral vasospasm based on tomographic imaging data

et al. 2017

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IntroductionQuantification of cerebral vasospasm after subarachnoid hemorrhage (SAH) is crucial in animal studies as well as clinical routine. We have developed a method for computer-based volumetric assessment of intracranial blood vessels from cross-sectional imaging data. Here we demonstrate the quantification of vasospasm from micro computed tomography (micro-CT) data in a rodent SAH model and the transferability of the volumetric approach to clinical data.MethodsWe obtained rodent data by performing an ex vivo micro-CT of murine brains after sham surgery or SAH by endovascular filament perforation on day 3 post hemorrhage. Clinical CT angiography (CTA) was performed for diagnostic reasons unrelated to this study. We digitally reconstructed and segmented intracranial vascular trees, followed by calculating volumes of defined vessel segments by standardized protocols using Amira® software.ResultsSAH animals demonstrated significantly smaller vessel diameters compared with sham (MCA: 134.4±26.9μm vs.165.0±18.7μm, p<0.05). We could highlight this difference by analyzing vessel volumes of a defined MCA-ICA segment (SAH: 0.044±0.017μl vs. sham: 0.07±0.006μl, p<0.001). Analysis of clinical CTA data allowed us to detect and volumetrically quantify vasospasm in a series of 5 SAH patients. Vessel diameters from digital reconstructions correlated well with those measured microscopically (rodent data, correlation coefficient 0.8, p<0.001), or angiographically (clinical data, 0.9, p<0.001).ConclusionsOur methodological approach provides accurate anatomical reconstructions of intracranial vessels from cross-sectional imaging data. It allows volumetric assessment of entire vessel segments, hereby highlighting vasospasm-induced changes objectively in a murine SAH model. This method could also be a helpful tool for analysis of clinical CTA.

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Section: Discussionmentioning

confidence: 99%

A segmentation-based volumetric approach to localize and quantify cerebral vasospasm based on tomographic imaging data

et al. 2017

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background: Computed tomography angiography (CTA) is frequently used with computed tomography perfusion imaging (CTP) to evaluate whether endovascular vasospasm treatment is indicated for subarachnoid hemorrhage patients with delayed cerebral ischemia. However, objective parameters for CTA evaluation are lacking. In this study, we used an automated, investigator-independent, digital method to detect vasospasm, and we evaluated whether the method could predict the need for subsequent endovascular vasospasm treatment. Methods:We retrospectively reviewed the charts and analyzed imaging data for 40 consecutive patients with subarachnoid hemorrhages. The cerebrovascular trees were digitally reconstructed from CTA data, and vessel volume and the length of the arteries of the circle of Willis and their peripheral branches were determined. Receiver operating characteristic curve analysis based on a comparison with digital subtraction angiographies was used to determine volumetric thresholds that indicated severe vasospasm for each vessel segment.Results: The automated threshold-based volumetric evaluation of CTA data was able to detect severe vasospasm with high sensitivity and negative predictive value for predicting cerebral hypoperfusion on CTP, although the specificity and positive predictive value were low. Combining the automated detection of vasospasm on CTA and cerebral hypoperfusion on CTP was superior to CTP or CTA alone in predicting endovascular vasospasm treatment within 24 h after the examination.Neulen et al. Automated Grading of Cerebral VasospasmsConclusions: This digital volumetric analysis of the cerebrovascular tree allowed the objective, investigator-independent detection and quantification of vasospasms. This method could be used to standardize diagnostics and the selection of subarachnoid hemorrhage patients with delayed cerebral ischemia for endovascular diagnostics and possible interventions.

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Blood Pressure Affects the Early CT Perfusion Imaging in Patients with aSAH Reflecting Early Disturbed Autoregulation

et al. 2023

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Background Early computed tomography perfusion (CTP) is frequently used to predict delayed cerebral ischemia following aneurysmatic subarachnoid hemorrhage (aSAH). However, the influence of blood pressure on CTP is currently controversial (HIMALAIA trial), which differs from our clinical observations. Therefore, we aimed to investigate the influence of blood pressure on early CTP imaging in patients with aSAH. Methods We retrospectively analyzed the mean transit time (MTT) of early CTP imaging within 24 h after bleeding prior to aneurysm occlusion with respect to blood pressure shortly before or after the examination in 134 patients. We correlated the cerebral blood flow with the cerebral perfusion pressure in the case of patients with intracranial pressure measurement. We performed a subgroup analysis of good-grade (World Federation of Neurosurgical Societies [WFNS] I–III), poor-grade (WFNS IV–V), and solely WFNS grade V aSAH patients. Results Mean arterial pressure (MAP) significantly correlated inversely with the mean MTT in early CTP imaging (R = − 0.18, 95% confidence interval [CI] − 0.34 to − 0.01, p = 0.042). Lower mean blood pressure was significantly associated with a higher mean MTT. Subgroup analysis revealed an increasing inverse correlation when comparing WFNS I–III (R = − 0.08, 95% CI − 0.31 to 0.16, p = 0.53) patients with WFNS IV–V (R = − 0.2, 95% CI − 0.42 to 0.05, p = 0.12) patients, without reaching statistical significance. However, if only patients with WFNS V are considered, a significant and even stronger correlation between MAP and MTT (R = − 0.4, 95% CI − 0.65 to 0.07, p = 0.02) is observed. In patients with intracranial pressure monitoring, a stronger dependency of cerebral blood flow on cerebral perfusion pressure is observed for poor-grade patients compared with good-grade patients. Conclusions The inverse correlation between MAP and MTT in early CTP imaging, increasing with the severity of aSAH, suggests an increasing disturbance of cerebral autoregulation with the severity of early brain injury. Our results emphasize the importance of maintaining physiological blood pressure values in the early phase of aSAH and preventing hypotension, especially in patients with poor-grade aSAH.

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The Value of Perfusion Computed Tomography (PCT) Imaging After Aneurysmal Subarachnoid Hemorrhage: A Review of the Current Data

Abstract: The present review demonstrates that PCT imaging is able to detect EBI as well as DCI in patients experiencing aSAH. As a consequence, this technique should be routinely implemented in monitoring strategies for this patient population.

Cited by 12 publications

References 20 publications

A segmentation-based volumetric approach to localize and quantify cerebral vasospasm based on tomographic imaging data

A segmentation-based volumetric approach to localize and quantify cerebral vasospasm based on tomographic imaging data

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

Blood Pressure Affects the Early CT Perfusion Imaging in Patients with aSAH Reflecting Early Disturbed Autoregulation

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