| Diagnostic threshold values of cerebral perfusion measured with computed tomography for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. | |
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MedLine Citation:
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PMID: 20689085 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Early diagnosis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage is critical but difficult. We analyzed diagnostic threshold values of CT perfusion for use in detection of DCI in patients with subarachnoid hemorrhage. METHODS: We prospectively enrolled patients with subarachnoid hemorrhage with CT perfusion on admission and at time of clinical deterioration or after 1 week if no deterioration occurred. The gold standard was the clinical diagnosis of DCI based on all clinical, laboratory, and imaging data except CT perfusion. Patients with failed imaging (n=6) and other causes of deterioration (n=45) were excluded for the current study. We measured CT perfusion values, including cerebral blood volume, blood flow, mean transit time (MTT), and time to peak in predefined regions of interest and then compared absolute perfusion and perfusion asymmetry for patients with and without DCI. Diagnostic threshold values for DCI were evaluated and sensitivity and specificity calculated for optimal thresholds. RESULTS: Of 85 eligible patients with subarachnoid hemorrhage, 50 had DCI; 35 patients with no clinical deterioration comprised the reference group. Cerebral blood flow was significantly lower, MTT higher, and perfusion asymmetry larger in patients with DCI. We found that largest absolute MTT and the MTT difference between hemispheres were good diagnostic tests. Diagnostic threshold values with optimal sensitivity and specificity were an MTT of 5.9 seconds and an MTT difference of 1.1 second. CONCLUSIONS: Thresholds for absolute MTT values and between-hemisphere MTT differences on CT perfusion can distinguish between patients with delayed cerebral ischemia and clinically stable patients. |
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Authors:
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Jan Willem Dankbaar; Nicolien Karen de Rooij; Mienke Rijsdijk; Birgitta K Velthuis; Catharine J M Frijns; Gabriel J E Rinkel; Irene C van der Schaaf |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-08-05 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-31 Completed Date: 2010-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1927-32 Citation Subset: IM |
Affiliation:
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Departments of Radiology, University Medical Center, Utrecht, The Netherlands. j.w.dankbaar@umcutrecht.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Brain / physiopathology, radiography* Brain Ischemia / etiology, physiopathology, radiography* Cerebrovascular Circulation / physiology* Delayed Diagnosis Female Hemodynamics Humans Image Processing, Computer-Assisted Male Middle Aged Predictive Value of Tests Prospective Studies ROC Curve Sensitivity and Specificity Subarachnoid Hemorrhage / complications, physiopathology, radiography* Tomography, X-Ray Computed / methods* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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