gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Significance of Transcranial Doppler Sonography and CT Angiography in Vasospasm Monitoring of the Middle Cerebral Artery

Meeting Abstract

  • Axel Neulen - Universitätsmedizin Mainz, Klinik für Neurochirurgie, Mainz, Deutschland
  • Tobias Pantel - Klinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
  • Michael Kosterhon - Klinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
  • Anna Mayer - Klinik für Neuroradiologie, Universitätsmedizin Mainz, Mainz, Deutschland
  • Marc A. Brockmann - Universitätsmedizin Mainz, Klinik und Poliklinik für Neuroradiologie, Mainz, Deutschland
  • Sven Rainer Kantelhardt - Klinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 177

doi: 10.3205/17dgnc740, urn:nbn:de:0183-17dgnc7402

Published: June 9, 2017

© 2017 Neulen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Posthemorrhagic cerebral vasospasm contributes to delayed neurological deterioration, a major cause of poor outcome after subarachnoid hemorrhage (SAH). Non-invasive diagnostics for vasospasm include blood flow velocities measured by transcranial Doppler sonography (TCD), assessment of vasospasm by CT angiography (CTA), and CT perfusion measurements (CTP). In the present study we assessed the correlation of TCD blood flow velocities and CTA vasospasm to examine whether CTA could be dispensible in patients with TCD exams of sufficient quality.

Methods: SAH patients with TCD vasospasm monitoring, CTA and CTP were identified retrospectively. Vessel diameters and vessel volumes of the M1 segments of the middle cerebral arteries were determined from CTA data using Amira software by following a standardized protocol. Vessel diameters and volumes were correlated with TCD blood flow velocities. Predictive values concerning presence of a perfusion deficit with consecutive indication for interventional vasospasm treatment were calculated for CTA and TCD.

Results: In 24 SAH patients, 84 CTA exams with corresponding CTP and TCD exam were identified. There was a negative correlation between vessel diameters and blood flow velocity (-0.59, p<0.001), and between vessel volume and blood flow velocity (-0.47, p<0.001) of the M1 segment. We found high negative predictive values concerning presence of a cerebral perfusion deficit for blood flow velocities >120 cm/s (100%) and CTA-derived vessel diameter < 2.5 mm (100%) or vessel volume < 7.5 µl/mm (97.6%), while positive predictive values were lower (25%, 20.5% and 14.5%).

Conclusion: Our data indicate similar conclusions from CTA and TCD concerning vasospasm of the M1 segment with indication for interventional treatment. Further studies are needed to confirm these results for other vascular segments.