Article
Heterogeneity of early perfusion computerized tomography measurement following subarachnoid hemorrhage as a predictor for poor outcome
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Authors
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Carolin Dietrich
- Neurochirurgische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
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Bernd Turowski
- Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität, Düsseldorf, Germany
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Kerim Beseoglu
- Neurochirurgische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
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Daniel Hänggi
- Neurochirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Germany
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Hans-Jakob Steiger
- Neurochirurgische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
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Marcel A. Kamp
- Neurochirurgische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Impairment of tissue oxygenation caused by inhomogenous microscopic blood flow distribution, the so-called capillary transit time heterogeneity might contribute to delayed cerebral ischemia (DCI). Therefore increasing heterogeneity of parenchymal perfusion might correlate with tissue hypoxia and DCI. Aim of the present study was to assess the value of heterogeneity of early perfusion computerized tomography measurement (PCT) in predicting poor outcome.
Method: 61 patients underwent an early PCT measurement within the first 12 hours after SAH. Heterogeneity of the mean transit time (MTT) and the time to peak of the residue function (Tmax) in individual patients were correlated with the dichotomized functional outcome initially upon admission (good grade, World Federation of Neurosurgeons Scale (WFNS)° 1-3 vs. poor grade, WFNS°4-5) and at 6 weeks (unfavorable, Glasgow Outcome Scale (GOS) 1-3 vs. favorable, GOS 4-5). Heterogeneity of cerebral perfusion was measured as the coefficient of variation of MTT and Tmax of a representative CAT-scan slice of the entire brain circumference. Further, MTT in the hemisphere of the ruptured aneurysm was compared to the contralateral hemisphere. For statistical analysis a Mann-Whitney Rank Sum Test for not normally distributed parameters was performed. Statistical significance was accepted with p<0.05.
Results: Upon admission, 25 patients were poor grade and 36 good grade. Poor grade SAH patients suffered from a significantly higher heterogeneity of MTT and Tmax in early PCT (p< 0.001 respectively). Heterogeneity of MTT as well as Tmax did not differ between both hemispheres independent of the site of the ruptured aneurysm (p > 0.05 respectively). Furthermore, patients with an unfavorable outcome at six weeks suffered from a significantly higher heterogeneity of MTT and Tmax in early PCT as compared to patients with a favorable outcome (p < 0.001 respectively).
Conclusions: Heterogeneity of cerebral perfusion correlates with initially poor neurological status and unfavorable outcome. Further, heterogeneity of cerebral perfusion does not differ between hemispheres irrespective of the site of the ruptured aneurysm, indicating absence of interterritorial differences in cerebral perfusion. Heterogeneity of PCT should be further evaluated as an independent predictor for the clinical outcome in aneurysmal SAH.
