gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Article

Send article

Perfusion/diffusion-weighted imaging protocol for the diagnosis of cerebral vasospasm and management of treatment after subarachnoid hemorrhage

Protokoll von perfusions- und diffusionsgewichteter Bildgebung zur Diagnose und Steuerung der Therapie des zerebralen Vasospasmus

Meeting Abstract

Search Medline for

  • corresponding author J. Beck - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • A. Raabe - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Lanfermann - Institut für Neuroradiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • J. Berkefeld - Institut für Neuroradiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • R. du Mesnil - Institut für Neuroradiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • M. Setzer - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • H. Vatter - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • R. Gerlach - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • F. Zanella - Institut für Neuroradiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • S. Weidauer - Institut für Neuroradiologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.06.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc192.shtml

Published: May 8, 2006

© 2006 Beck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: To describe our protocol of perfusion/diffusion weighted imaging (PWI/DWI) in patients with SAH for the diagnosis of cerebral vasospasm and for treatment decisions as well as for monitoring of treatment effects.

Methods: Evaluation of contrast medium passage after standardized application with the bolus tracking method allowed calculation of time to peak (TTP) in all major vessel territories. Tissue at risk was diagnosed by perfusion delays in individual vessel territories without a DWI lesion as compared to reference territories. Transluminal balloon angioplasty (TBA) was used to dilate spastic arteries. The MR protocol was repeated after TBA. Combined PWI/DWI was used in 96 patients repeatedly so far. All H&H-grades and ventilated patients were included. Outcome was assessed at 6 months according to the modified Rankin scale (RS).

Results: 17 patients were selected for TBA because of mismatch of perfusion. Quantitative analysis of 10 patients revealed perfusion deficits of 2.1 to 16.4 s (6.5±0.88 s). Dilatation improved misery perfusion, resulting in a TTP decrease in the appendant territories of -4.67±0.73 s without infarcts and of -2.40±0.95 s with small infarcts. In contrast, without TBA, the additional TTP delay was +6.09±2.37 s and follow up MRI showed that in all territories large infarcts occurred. The triple-H therapy could be stopped.

Conclusions: With PWI/DWI one is able to diagnose cerebral vasospasm that is indeed leading to tissue misery-perfusion constituting tissue at risk. Based on the PWI/DWI findings one is able to make treatment decisions including TBA or halting triple H. Also treatment effects can be monitored as demonstrated on the on hand by resolution of mismatch by TBA and rescue of tissue and on the other hand by the development of infarcts if the perfusion deficit persisted. PWI/DWI in SAH is a feasible, safe and effective tool to diagnose cerebral vasospasm and to decide and monitor treatment.