Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: Qualitative and quantitative analysis of 3D parameter maps

• Published in: European journal of radiology 2014-10, Vol.83 (10), p.1881-1889
• Main Authors: Dolatowski, K, Malinova, V, Frölich, A.M.J, Schramm, R, Haberland, U, Klotz, E, Mielke, D, Knauth, M, Schramm, P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain imaging; Cerebral Angiography - methods; Cerebral vasospasm; Contrast Media; CT perfusion; Diagnosis, Differential; Female; Humans; Imaging, Three-Dimensional; Iopamidol - analogs & derivatives; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Radiology; Secondary ischemia; Sensitivity and Specificity; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Tomography, X-Ray Computed - methods; Vasospasm, Intracranial - diagnostic imaging; Vasospasm, Intracranial - etiology
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2014.06.020

Abstract Object Cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) implies high risk for secondary ischemia. It requires early diagnosis to start treatment on time. We aimed to assess the utility of “whole brain” VPCT for detecting localization and characteristics of arterial vasospasm. Methods 23 patients received a non-enhanced CT, VPCT and CTA of the brain. The distribution of ischemic lesions was analyzed on 3D-perfusion-parameter-maps of CBF, CBV, MTT, TTS, TTP, and TTD. CT-angiographic axial and coronal maximum-intensity-projections were reconstructed to determine arterial vasospasm. CT-data was compared to DSA, if performed additionally. Volume-of-interest placement was used to obtain quantitative mean VPCT values. Results 82% patients ( n = 19) had focal cerebral hypoperfusion. 100% sensitivity and 100% specificity was found for TTS (median 1.9 s), MTT (median 5.9 s) and TTD (median 7.6 s). CBV showed no significant differences. In 78% ( n = 18) focal vessel aberrations could be detected either on CTA or DSA or on both. Conclusion VPCT is a non-invasive method with the ability to detect focal perfusion deficits almost in the whole brain. While DSA remains to be the gold standard for detection of CV, VPCT has the potential to improve noninvasive diagnosis and treatment decisions.