Radiological alliance for health services researchComparison of CT Perfusion and Digital Subtraction Angiography in the Evaluation of Delayed Cerebral Ischemia
Section snippets
Study Population
A retrospective study of A-SAH patients was performed from consecutive patients admitted at our institution between December 2004 and December 2008. Inclusion criteria were adult patients (18 years and older) with documented A-SAH at admission and who underwent both CTP and DSA during hospitalization. During the time of this study, CTP was performed as routine imaging for A-SAH patients. DSA was performed in patients who had signs or symptoms of vasospasm and for follow-up evaluation of
Study Population Characteristics
A total of 108 patients were admitted to our institution with A-SAH between December 2004 and December 2008. CTP was performed in 104 patients and DSA was performed in 57 of these 104 patients. Therefore, 57 patients (those who had both CTP and DSA) were included in this study. Seventy-nine percent (45/57) were classified as DCI and 21% (12/57) as no DCI according to the reference standard. The clinical and demographic characteristics of the study population are presented in Table 1. The age
Discussion
DCI is a devastating condition that occurs secondary to A-SAH and contributes to significant morbidity and mortality in this patient population. A diagnosis of DCI is based on clinical criteria for the presence of clinical deterioration not explained by other causes or imaging criteria for new infarction not attributed to the initial hemorrhagic event or postoperative changes (2). The difficulty with using this definition of DCI in clinical practice is that once infarction has occurred,
Conclusion
In summary, this study demonstrates that CTP and DSA have similar test characteristics for determining DCI in A-SAH patients. Performing Bayesian analysis in this study population illustrates the situations when testing with CTP and DSA will likely be useful. This application of probability theory provides a better understanding of the appropriate utilization of CTP and DSA in clinical practice for patients with low and high HH grades.
References (26)
- et al.
The effect of varying user-selected input parameters on quantitative values in CT perfusion maps
Acad Radiol
(2004) - et al.
The meaning of diagnostic test results: a spreadsheet for swift data analysis
Clin Radiol
(2000) - et al.
Cerebral vasospasm following subarachnoid hemorrhage: time for a new world of thought
Neurol Res
(2009) - et al.
Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition?
Stroke
(2009) - et al.
Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited
Stroke
(2001) - et al.
Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography. Part 1. Reliability of flow velocities in clinical management
Neurosurgery
(1993) - et al.
Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?
Neurosurg Focus
(2006) - et al.
Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group
Stroke
(2010) - et al.
Computed tomographic perfusion in the management of aneurysmal subarachnoid hemorrhage: new application of an existent technique
Neurosurgery
(2005) - et al.
Monitoring cerebral perfusion after subarachnoid hemorrhage using CT
Neuroradiology
(2001)
Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management
AJNR Am J Neuroradiol
Quantitative assessment of regional cerebral blood flows by perfusion CT studies at low injection rates: a critical review of the underlying theoretical models
Eur Radiol
The anterior cerebral artery is an appropriate arterial input function for perfusion-CT processing in patients with acute stroke
Neuroradiology
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A.D. was partially supported by Clinical Translational Science Center (CTSC) (NIH UL1-RR024996). This publication was made possible by Grant Number 5K23NS058387-02 from the National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NINDS or NIH.