Can CT Perfusion Guide Patient Selection for Treatment of Delayed Cerebral Ischemia?

Pina C. Sanelli, Rachel Gold, Nikesh Anumula, Austin Ferrone, Carl E. Johnson, Joseph P. Comunale, Apostolos J. Tsiouris, Howard Riina, Halinder Mangat, Axel Rosengart, Alan Z. Segal

Department of Neurological Surgery, Weill Cornell Medical College, New York, USA.
Department of Neurology, Weill Cornell Medical College, New York, USA.
Department of Radiology, Weill Cornell Medical College, New York, USA.

DOI: 10.4236/act.2013.21002                

Abstract

Purpose: To evaluate qualitative and quantitative CT perfusion (CTP) for different treatment options of delayed cerebral ischemia (DCI) in aneurysmal SAH. Methods: Retrospective study of consecutive SAH patients enrolled in a prospective IRB-approved clinical trial. Qualitative analysis of CTP deficits were determined by two blinded neuroradiologists. Quantitative CTP was performed using standardized protocol with region-of-interest placement sampling the cortex. DCI was assessed by clinical and imaging criteria. Patients were classified into treatment groups: 1) hypertension-hemodilution-hypervolemia (HHH); 2) intra-arterial (IA) vasodilators and/or angioplasty; 3) no treatment. Mean quantitative CTP values were compared using ANOVA pairwise comparisons. Receiver operating characteristic (ROC) curves, standard error (SE) and optimal threshold values were calculated. Results: Ninety-six patients were classified into three treatment groups; 21% (19/96) HHH, 34% (33/96) IA-therapy and 46% (44/96) no treatment. DCI was diagnosed in 42% (40/96); of which 18% (7/40) received HHH, 80% (32/40) IA-therapy, and 2% (1/40) no treatment. CTP deficits were seen in 50% (48/96); occurring in 63% (12/19) HHH, 94% (31/33) IA-therapy, and 11% (5/44) no treatment. Presence of CTP deficits had 83% sensitivity, 89% specificity, 90% positive predictive and 81% negative predictive values for treatment. Mean quantitative CTP values revealed significant differences in CBF (p < 0.0001) and MTT (p = 0.0001) amongst the treatment groups. ROC analysis revealed CBF with the highest accuracy of 0.82 (SE 0.04) for comparing treatment groups. Threshold analysis calculated CBF of 30 mL/100 gm/min (89% specificity, 71% sensitivity) for determining treatment. Conclusion: These initial findings of significant differences in CTP deficits for different treatment groups suggest that CTP may have a potential role in guiding patient selection for treatment of DCI.

Keywords

CT Perfusion; Aneurysmal Subarachnoid Hemorrhage; Delayed Cerebral Ischemia; Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

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