Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ohkuma, H. Articles by Kikkawa, T. Search for Related Content PubMed PubMed Citation Articles by Ohkuma, H. Articles by Kikkawa, T.

American Journal of Neuroradiology 24:444-450, March 2003
© 2003 American Society of Neuroradiology

BRAIN

Cortical Blood Flow during Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: Three-Dimensional N-Isopropyl-p-[¹²³I]Iodoamphetamine Single Photon Emission CT Findings

Hiroki Ohkuma^a, Shigeharu Suzuki^a, Kanae Kudo^a, Shafiqul Islam^a and Tomonari Kikkawa^a

^a From the Department of Neurosurgery, Hirosaki University School of Medicine, Japan

Address reprint requests to Hiroki Ohkuma, MD, Department of Neurosurgery, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8216 Japan

BACKGROUND AND PURPOSE: The relationship between regional cerebral blood flow (rCBF) during cerebral vasospasm after subarachnoid hemorrhage (SAH) and angiographic vasospasm and the value of rCBF in predicting vasospasm and the prognosis are not fully delineated. Our aim was to investigate the changes in extent of vasospasm-induced decreased cortical rCBF on three-dimensional (3D) displays of single photon emission CT (SPECT) findings. The clinical usefulness of these assessments was analyzed.

METHODS: In 58 cases of SAH, SPECT and digital subtraction angiography were performed on the same day, 5–9 days after SAH or within 24 hours after the onset of delayed ischemic neurologic deficit (DIND). Cerebral blood flow data were assessed by measuring the area of decreased cortical rCBF on 3D SPECT images.

RESULTS: The area of decreased cortical rCBF on the 3D images was significantly increased in cases with DIND (P < .001), in cases with a large infarction due to vasospasm (P = .006), and in cases with a poor prognosis after vasospasm (P = .045). These increases were also related to the type of angiographic vasospasm; the greatest decrease in cortical rCBF occurred in the combined type (combination of the peripheral and proximal types) of vasospasm, followed by cases with the peripheral type, proximal type, and no angiographic vasospasm. In cases with DIND, patchy decreased cortical rCBF areas were seen before the onset of DIND.

CONCLUSION: Combined-type vasospasm leads to reductions in CBF greater than those due to isolated peripheral or proximal vasospasm. Two-dimensional and mean-hemispheric CBF analyses are less sensitive for this change than is 3D SPECT.