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

Caspers, Julian; Rubbert, Christian; Turowski, Bernd; Martens, Daniel; Reichelt, D; R, May; Aissa, Joel; Hänggi, Daniel; Etminan, Nima; Mathys, Christian

doi:10.1007/s00062-015-0399-6

Cited by 13 publications

(8 citation statements)

References 44 publications

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“…Some studies have indicated that cerebral circulation time (CCT) can reflect the status of microcirculatory impairment. [17][18][19] Several studies using computed tomography perfusion have examined the relationship between DCI and indicators related to the CCT, such as the mean transit time (MTT) and the time to peak (TTP), but they did not reach a definite conclusion about their relationship to DCI, and a consensus among studies could therefore not be reached. [20][21][22][23][24][25][26][27][28][29][30][31][32] Digital subtraction angiography (DSA) is recognized as the most reliable method for the evaluation of CCT and aVS.…”

Section: Introductionmentioning

confidence: 99%

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Naraoka

Matsuda

Shimamura

et al. 2021

J Cereb Blood Flow Metab

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Early brain injury (EBI) is considered an important cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). As a factor in EBI, microcirculatory dysfunction has become a focus of interest, but whether microcirculatory dysfunction is more important than angiographic vasospasm (aVS) remains unclear. Using data from 128 cases, we measured the time to peak (TTP) in several regions of interest on digital subtraction angiography. The intracerebral circulation time (iCCT) was obtained between the TTP in the ultra-early phase (the baseline iCCT) and in the subacute phase and/or at delayed cerebral ischemia (DCI) onset (the follow-up iCCT). In addition, the difference in the iCCT was calculated by subtracting the baseline iCCT from the follow-up iCCT. Univariate analysis showed that DCI was significantly increased in those patients with a prolonged baseline iCCT, prolonged follow-up iCCT, increased differences in the iCCT, and with severe aVS. Poor outcome was significantly increased in patients with prolonged follow-up iCCT and increased differences in the iCCT. Multivariate analysis revealed that increased differences in the iCCT were a significant risk factor that increased DCI and poor outcome. The results suggest that the increasing microcirculatory dysfunction over time, not aVS, causes DCI and poor outcome after aneurysmal aSAH.

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Section: Introductionmentioning

confidence: 99%

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Naraoka

Matsuda

Shimamura

et al. 2021

J Cereb Blood Flow Metab

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“…However, PBV only provides cerebral blood volume values at present but lacks perfusion parameters of CBF, MTT, and TTP. The evaluation of patients who have no obvious CBV abnormalities in the early stage, with only prolonged MTT and slightly decreased CBF, may be inaccurate ( 48 ). Improved PBV technology that can calculate more perfusion parameters in the future may help in a more comprehensive and accurate evaluation of the brain perfusion status ( 55 ).…”

Section: Discussionmentioning

confidence: 99%

“…These results are in concordance with the cerebral pathological changes after aneurysmal SAH. CBF could maintain stability in patients with intact autonomic regulation (45)(46)(47), but increased intracranial pressure (ICP) and decreased CBF after aneurysmal SAH lead to congestive changes in brain tissue manifested by dilated cerebral arterioles and increased CBV in patients with impaired autonomic regulation (11,48,49). The blood supply of the parietal ROIs that we selected was covered by the middle cerebral artery, which responded immediately after hemorrhage and manifested as cerebral congestion, resulting in increased PBV in the parietal ROIs.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Wen

Zhou

et al. 2022

Front. Neurol.

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PurposeAneurysmal subarachnoid hemorrhage (SAH) is accompanied by cerebral perfusion changes. We aimed to measure the parenchymal blood volume (PBV) maps acquired by C-arm flat-panel detector CT (FDCT) to assess the cerebral blood volume at an early stage in aneurysmal SAH and to explore the correlation with the outcomes at discharge.MethodsData of 66 patients with aneurysmal SAH who underwent FDCT PBV examination were retrospectively analyzed. The PBV of regions of interest, including the cortices of the bilateral frontal lobe, the parietal lobe, the occipital lobe, and the cerebral hemisphere, as well as the basal ganglia, were measured and quantitatively analyzed. The clinical and imaging data of the patients were also collected, and logistic regression analysis was performed to explore the correlation between the perfusion parameters and outcomes at discharge.ResultsThe favorable and poor outcomes at discharge were found in 37 (56.06%) and 29 (43.94%) patients, respectively. The whole-brain PBV was significantly correlated with the Hunt-Hess grades (p < 0.005) and the WFNSS grades (p < 0.005). The whole-brain PBV of the poor prognosis was significantly higher than that of the favorable prognosis (35.17 ± 7.66 vs. 29.78 ± 5.54, p < 0.005). The logistic regression analysis showed that the PBV of the parietal lobe at the bleeding side (OR = 1.10, 95%CI: 1.00–1.20, p = 0.04) was an independent risk factor predicting the short-term prognosis.ConclusionsParenchymal blood volume (PBV) maps could reflect the cerebral blood volume throughout the brain to characterize its perfusion status at an early stage in aneurysmal SAH. It enables a one-stop imaging evaluation and treatment in the same angio-suite and may serve as a reliable technique in clinical assessment of aneurysmal SAH.

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“…The few published studies included mostly early CT perfusion evaluations, before the vasospasm time window. One recent study found that the earliest the perfusion changes occur, the higher likelihood of poor outcome in patients with DCI (76). From all perfusion parameters, MTT seems to be the most significant regarding outcome prediction.…”

Section: Imaging Predictors Of Clinical Outcomementioning

confidence: 99%

Imaging predictors of outcome in acute spontaneous subarachnoid hemorrhage: a review of the literature

Fragata

Canhão

2018

Acta Radiol

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Spontaneous subarachnoid hemorrhage (SAH) accounts for about 5% of strokes, but has a very high morbidity and mortality. Many survivors are left with important cognitive impairment and are severely incapacitated. Prediction of complications such as vasospasm and delayed cerebral ischemia, and of clinical outcome after SAH, is challenging. Imaging studies are essential in the initial evaluation of SAH patients and are increasingly relevant in assessing for complications and prognosis. In this article, we reviewed the role of imaging studies in evaluating early brain injury and predicting complications as well as clinical and neuropsychological prognosis after acute SAH.

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

Abstract: The current findings suggest a presumably higher vulnerability of the brain to early microcirculatory impairments after aSAH and highlight that timing of MTT elevations could be considered for the identification of patients at increased risk for poor neurological outcome due to DCI.

Cited by 13 publications

References 44 publications

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Imaging predictors of outcome in acute spontaneous subarachnoid hemorrhage: a review of the literature

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