Artikel
Perfusion computerised tomography for the management of patients with severe aneurysmal subarachnoid haemorrhage
Der Einsatz der Perfusions-Computertomographie für das Management von Patienten nach schwerer Subarachnoidalblutung
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Autoren
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D. Hänggi
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
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B. Turowski
- Radiologische Klinik, Abteilung für Neuroradiologie, Heinrich-Heine-Universität, Düsseldorf
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H.-J. Steiger
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf
| Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: The application of computerised tomography (CT) perfusion studies for stroke has been well documented and validated. For the observation of cerebral vasospasm after subarachnoid haemorrhage (SAH), first studies have been reported without standardised parameters to quantify perfusion. This single-centre prospective study was initiated to correlate accepted identifiers of vasospasm after SAH with CT-perfusion measurements.
Methods: 50 patients suffering from SAH Fisher grade 3 and 4 were included in the study, approved by the local ethics committee. In addition to our routine SAH management with clinical evaluation, daily transcranial Doppler (TCD), CT and cerebral angiography (DSA), the study patients received CT-perfusion measurements on day 1, day 3-4 and day 9-11 after SAH. Additional CT-perfusion studies were performed in cases of suspected vasospasm by the routine monitoring tools. The data of the routine tools were correlated with the parameters of CT-perfusion studies (mean transit time, MTT; time to peak, Tmax; regional cerebral blood flow, CBF and regional cerebral blood volume, CBV).
Results: Overall MTT was found to be the most sensitive parameter in correlation to the documented clinical course of the patients. Moreover,MTT demonstrated the highest sensitivity and specificity in relation to TCD data and DSA. In our study group, patients with MTT below 3 s showed no signs of clinical deterioration, TCD values <150cm/s and non-spastic vessels at angiography. None or minor delayed neurological deficits were seen in patients with a MTT between 3.1 s to 3.9 s; TCD values demonstrated accelerated flow and angiography irregularly demonstrated narrowed vessels. For patients with a MTT larger than 4 s, clinical deficits were seen regularly as well as high mean flow velocities on TCD and definite vasospasm on the angiogram.
Conclusions: CT-perfusion measurement is a sensitive, simple and non-invasive diagnostic tool for the management of patients after SAH. Our classification of MTT allows a correlation to the clinical condition and can also be used to predict in advance clinical deficits related to vasospasm.
