Assessment of tissue permeability by early CT perfusion as a surrogate parameter for early brain injury after subarachnoid hemorrhage

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  • 1 Departments of Neurosurgery and
  • 2 Neuroradiology, Georg-August-University, Göttingen, Germany; and
  • 3 Department of Neuroradiology, University Hospital Basel, Switzerland
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OBJECTIVE

The severity of early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) correlates with delayed cerebral ischemia (DCI) and outcome. A disruption of the blood-brain barrier is part of EBI pathophysiology. The aim of this study was to assess tissue permeability (PMB) by CT perfusion (CTP) in the acute phase after aSAH and its impact on DCI and outcome.

METHODS

CTP was performed on day 3 after aSAH. Qualitative and quantitative analyses of all CTP parameters, including PMB, were performed. The areas with increased PMB were documented. The value of an early PMB increase as a predictor of DCI and outcome according to the modified Rankin Scale (mRS) grade 3 to 24 months after aSAH was assessed. Possible associations of increased PMB with the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) and with early perfusion deficits, as radiographic EBI markers, were evaluated.

RESULTS

A total of 69 patients were enrolled in the study. An increased PMB on early CTP was detected in 10.1% (7/69) of all patients. A favorable outcome (mRS grade ≤ 2) occurred in 40.6% (28/69) of all patients. DCI was detected in 25% (17/69) of all patients. An increased PMB was a predictor of DCI (logistic regression, p = 0.03) but not of outcome (logistic regression, p = 0.40). The detection of increased PMB predicted DCI with a sensitivity of 25%, a specificity of 94%, a positive predictive value of 57%, and a negative predictive value of 79% (chi-square test p = 0.03). Early perfusion deficits were seen in 68.1% (47/69) of the patients, a finding that correlated with DCI (p = 0.005) but not with the outcome. No correlation was found between the SEBES and increased PMB.

CONCLUSIONS

Changes in PMB can be detected by early CTP after aSAH, which correlates with DCI. Future studies are needed to evaluate the time course of PMB changes and their interaction with therapeutic measures.

ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; BBB = blood-brain barrier; BFV = blood flow velocity; CTP = CT perfusion; DCI = delayed cerebral ischemia; EBI = early brain injury; mRS = modified Rankin Scale; NPV = negative predictive value; PMB = permeability; PPV = positive predictive value; SEBES = Subarachnoid Hemorrhage Early Brain Edema Score; VOI = volume of interest.

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Contributor Notes

Correspondence Vesna Malinova: Georg-August-University, Göttingen, Germany. vesna.malinova@gmail.com.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS19765.

M.N.P. and D.M. contributed equally to this work and share senior authorship.

Disclosures Dr. Psychogios reports receiving speaker honoraria from Siemens.

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