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AJNR - American Journal of Neuroradiology

Published ahead of print on October 26, 2007
doi: 10.3174/ajnr.A0747

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American Journal of Neuroradiology 29:79-85, January 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

CT Perfusion-Derived Mean Transit Time Predicts Early Mortality and Delayed Vasospasm after Experimental Subarachnoid Hemorrhage

A.M. Laslo^a,b,c, J.D. Eastwood^d, P. Pakkiri^c, F. Chen^a,b,c and T.Y. Lee^a,b,c

^a Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
^b Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
^c Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
^d Department of Radiology, Duke University Medical Center, Durham, NC

Please address correspondence to Ting-Yim Lee, PhD, Imaging Research Laboratories, Robarts Research Institute, 100 Perth Dr, London, ON, Canada, N6A 5K8; e-mail: tlee{at}imaging.robarts.ca

BACKGROUND AND PURPOSE: There are limited indicators available to predict cerebral vasospasm in patients with subarachnoid hemorrhage (SAH). The purpose of this study was to determine if CT perfusion–derived hemodynamic parameters are predictors of vasospasm severity and outcome after experimental SAH.

MATERIALS AND METHODS: SAH was induced in 25 New Zealand white rabbits. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were measured with CT perfusion before SAH, within 1 hour after SAH, and on days 2, 4, 7, 9, and 16 after SAH. Basilar artery diameter, measured with CT angiography and neurologic scoring, was also obtained on the same days. Differences between animals with moderate-severe delayed vasospasm (24% basilar artery narrowing) and mild delayed vasospasm (<24% basilar artery narrowing) were investigated with repeated measures analysis of variance. Multiple linear regression analysis was used to investigate the relationship between CT perfusion parameters (CBF, CBV, MTT), basilar artery diameter, and neurologic score.

RESULTS: MTT increase <1 hour after SAH independently predicted mortality within 48 hours of SAH (P < .05). MTT and neurologic deficits were significantly greater with moderate-severe than with mild vasospasm (P < .05). MTT on day 2, but not CBF or CBV, was a significant predictor of subsequent moderate-severe delayed vasospasm (P < .05).

CONCLUSION: In the rabbit model of experimental SAH, the CT-derived hemodynamic parameter MTT on day 0 predicted early mortality, and MTT on day 2 predicted development of moderate-severe delayed vasospasm. MTT was also significantly correlated with arterial diameter and neurologic score.