Article
Impact of microcirculatory changes on cerebral blood flow during vasospasm after subarachnoid hemorrhage – a multimodal MRI study
Der Einfluss der Mikrozirkulation auf den zerebralen Blutfluss bei SAB-assoziierten Vasospasmen – Eine multimodale MRT-Studie
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Authors
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L. Rödel
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
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H. Roth
- Abteilung für Neuroradiologie der Universität Leipzig
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C. Renner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
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J. Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig
| Published: | April 11, 2007 |
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Outline
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Objective: Cerebral microcirulatory changes during cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) are still controversial and uncertain. Multimodal MRI allows the early detection of changes in the cerebral perfusion pattern and is able to detect DIND at a very early stage of the disease.
Methods: In 25 patients with aneurysmal SAH, daily TCD (transcranial Doppler sonography) and sequential Perfusion- and - Diffusion MRI were performed. During the pronounced phase of VSP, we also performed cerebral angiography as a gold standard for the macrovasculatur path line. The MR-data processing was done by the Dptools® software. We defined correspondig regions of interest in the MCA, ACA and ACP territories. Cm(t) maps (concentration of gadolinium with time) and regions of interest of Time to Peak (rTTP), Cerebral Blood Flow (rCBF), Cerebral Blood Volume (rCBV) and Mean transit Time (rMTT) in brain tissue were calculated on a voxel-by-voxel basis.
Results: Constant or slightly decreased relative cerebral blood volume (rCBV) /cerebral blood flow (rCBF) in combination with Time to peak (TTP) up to 3 s indicates a sufficient cerebral perfusion. A highly increased TTP (>4 s) in combination with a decreased rCBV and rCBF is highly correlated to DIND. Perfusion-parameters and cerebral angiography show a high correlation for the detection of VSP of the macrovascular path line. All examined patients without remarkable VSP in the cerebral angiogram indicate changes in the microvasculature path line interpretable as VSP. Our findings reveal that DIND arises only if VSP could be demonstrated in both the macro- and the microvascular- path line.
Conclusions: Changes in the microvascular path line are related to the pathogenesis of SAH-related DIND. Our results strongly point out that the combination of macro and microvascular disturbances lead to DIND. Multimodal MRI is a powerful tool for characterizing VSP associated with circulatory disturbances.
