HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pham, M. Articles by Bendszus, M. Search for Related Content PubMed PubMed Citation Articles by Pham, M. Articles by Bendszus, M. Related Collections CT All Clinical trials Infarction Subarachnoid hemorrhage

CT perfusion predicts secondary cerebral infarction after aneurysmal subarachnoid hemorrhage

From the Departments of Neuroradiology (M.P., A.W., A.J.B., L.S., M.B.), Neurosurgery (C.L., K.R.), and Neurology (W.M.), University of Würzburg, Germany.

Address correspondence and reprint requests to Dr. M. Pham, Department of Neuroradiology, University of Würzburg, Josef-Schneider-Str.11, D-97080 Würzburg, Germany pham{at}neuroradiologie.uni-wuerzburg.de

Objective: 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).

Methods: 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.

Results: 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 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.

Conclusions: Time to peak as indicated by CT perfusion is a sensitive and early predictor of secondary cerebral infarction.

M.B. holds a professorship donated by Schering GmbH (Berlin, Germany) to the University of Würzburg but has no financial interest.

Disclosure: The authors report no conflicts of interest.

Received November 7, 2006. Accepted in final form March 22, 2007.

This article has been cited by other articles:

				J. W. Dankbaar, N. K. de Rooij, B. K. Velthuis, C. J.M. Frijns, G. J.E. Rinkel, and I. C. van der Schaaf Diagnosing Delayed Cerebral Ischemia With Different CT Modalities in Patients With Subarachnoid Hemorrhage With Clinical Deterioration Stroke, November 1, 2009; 40(11): 3493 - 3498. [Abstract] [Full Text] [PDF]

				A.A. Konstas, G.V. Goldmakher, T.-Y. Lee, and M.H. Lev Theoretic Basis and Technical Implementations of CT Perfusion in Acute Ischemic Stroke, Part 1: Theoretic Basis AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 662 - 668. [Abstract] [Full Text] [PDF]