CT perfusion predicts secondary cerebral infarction after aneurysmal subarachnoid hemorrhage

• Published in: Neurology Vol. 69; no. 8; p. 762
• Main Authors: Pham, M, Johnson, A, Bartsch, A J, Lindner, C, Müllges, W, Roosen, K, Solymosi, L, Bendszus, M
• Format: Journal Article
• Language: English
• Published: United States 21.08.2007
• Subjects: Adult; Aged; Aged, 80 and over; Brain - blood supply; Brain - pathology; Brain - physiopathology; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - physiopathology; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Cerebral Infarction - physiopathology; Cerebrovascular Circulation - physiology; Humans; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Sensitivity and Specificity; Subarachnoid Hemorrhage - complications; Time Factors; Tomography, X-Ray Computed - methods; Ultrasonography, Doppler, Transcranial - methods
• ISSN: 1526-632X
• DOI: 10.1212/01.wnl.0000267641.08958.1b

To prospectively assess the diagnostic accuracy of CT perfusion (CTP) and transcranial Doppler sonography (TCD) for the prediction of secondary cerebral infarction (SCI) after aneurysmal subarachnoid hemorrhage (SAH). During 2 weeks after SAH, 38 consecutive patients completed an average of 3.5 CT/CTP and 10.7 TCD examinations at regular intervals as required by the study protocol. SCI was defined as delayed infarction on native CT between 3 and 14 days after SAH and developed in n = 14 patients (n = 24 without SCI). Analysis was based on examination dates before SCI. Common measures of diagnostic accuracy were calculated for qualitative CTP (visual color-map ratings from two blinded observers) and TCD assessments (mean flow velocity >120 cm/s in anterior, middle, and posterior cerebral artery territories). Quantitative measures, which for CTP were obtained from cortical a priori regions of interest corresponding to the vascular territories, were analyzed by binary logistic regression. Time of prediction for SCI by CTP was at a median of 3 days (range 2 to 5 days) before manifestation of complete infarction on native CT. Visual assessment of time-to-peak (TTP) color maps performed best for the prediction of SCI with 0.93 sensitivity (95% CI: 0.7 to 1.0) and 0.67 specificity (95% CI: 0.53 to 0.7). On quantitative analysis, the odds ratio (OR) for 1 second of side-to-side delay in TTP was 1.4 (p = 0.01, Wald chi(2) = 8.57, CI: 1.07 to 1.82). Daily TCD measures were not significantly related to SCI at any time before complete infarction on native CT. Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.