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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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EBI following aneurysmal SAH results in a homogeneous perfusion impairment in early CT perfusion imaging

EBI nach aneurysmatischer SAB ist mit einer homogenen Perfusionsstörung in der frühen CT-Perfusionsbildgebung vergesellschaftet

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  • presenting/speaker Björn B. Hofmann - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Igor Fischer - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Daniel M. Donaldson - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Cihat Karadag - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Kerim Beseoglu - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Jasper Hans van Lieshout - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Sajjad Muhammad - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Bernd Turowski - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • Daniel Hänggi - Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
  • Christian Rubbert - Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
  • Marcel A. Kamp - Universitätsklinikum Jena, Klinik und Poliklinik für Neurochirurgie, Jena, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV197

doi: 10.3205/22dgnc191, urn:nbn:de:0183-22dgnc1910

Published: May 25, 2022

© 2022 Hofmann 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

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Objective: Recently, poor outcome after aSAH has been linked to increased MTT-heterogeneity, a possible marker of capillary transit time heterogeneity, in the DCI phase. In addition to DCI, there is increasing interest in the concept of early brain injury (EBI), which assumes a more global perfusion restriction of the brain at an early stage. We therefore hypothesised that the EBI-related perfusion impairment affects the entire brain homogeneously, and thus heterogeneity of early perfusion imaging after SAH is not an independent predictor of patient outcome.

Methods: We retrospectively analysed the heterogeneity of the MTT using the coefficient of variation in early CTP scans (within 24h after ictus) from 124 SAH patients. Analyses were performed for the whole study population and the subgroups of patients with or without EVD at the time of early CTP imaging. Both, linear and logistic regression were used to model the mRS outcome, treated as numerical and dichotomised values, respectively. Linear regression was used to investigate linear dependency between variables. Student’s t-test was used to compare the means of 2 groups.

Results: No significant difference in coefficient of variation for MTT between patients with or without EVD at the time of early CTP imaging could be observed (p = 0.69). We found no correlation between the coefficient of variation for MTT in early CTP imaging and initial modified Fisher (p=0.07) and World Federation of Neurosurgical Societies grades (p = 0.23). The coefficient of variation for MTT in early perfusion imaging did not significantly correlate with the 6-month-mRS neither for the entire study population (p = 0.15) nor for any of the subgroups (without EVD: p = 0.21; with EVD: p = 0.3).

Conclusion: Heterogeneity of MTT in early CTP after aneurysmal SAH does not correlate with the patients´ outcome. In contrast, the heterogeneity of MTT in the phase of DCI is a potent predictor of patient outcome. The present study confirms our hypothesis that capillary transit time heterogeneity, measured by the cvMTT, appears neither clinically nor physiologically relevant in the phase of EBI and therefore does not represent an early predictor for the 6-month outcome following aSAH.