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Volume perfusion CT imaging of cerebral vasospasm: diagnostic performance of different perfusion maps

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

In this study, we aimed to evaluate the diagnostic performance of different volume perfusion CT (VPCT) maps regarding the detection of cerebral vasospasm compared to angiographic findings.

Methods

Forty-one datasets of 26 patients (57.5 ± 10.8 years, 18 F) with subarachnoid hemorrhage and suspected cerebral vasospasm, who underwent VPCT and angiography within 6 h, were included. Two neuroradiologists independently evaluated the presence and severity of vasospasm on perfusion maps on a 3-point Likert scale (0—no vasospasm, 1—vasospasm affecting <50 %, 2—vasospasm affecting >50 % of vascular territory). A third neuroradiologist independently assessed angiography for the presence and severity of vasospasm on a 3-point Likert scale (0—no vasospasm, 1—vasospasm affecting < 50 %, 2—vasospasm affecting > 50 % of vessel diameter). Perfusion maps of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and time to drain (TTD) were evaluated regarding diagnostic accuracy for cerebral vasospasm with angiography as reference standard. Correlation analysis of vasospasm severity on perfusion maps and angiographic images was performed. Furthermore, inter-reader agreement was assessed regarding findings on perfusion maps.

Results

Diagnostic accuracy for TTD and MTT was significantly higher than for all other perfusion maps (TTD, AUC = 0.832; MTT, AUC = 0.791; p < 0.001). TTD revealed higher sensitivity than MTT (p = 0.007). The severity of vasospasm on TTD maps showed significantly higher correlation levels with angiography than all other perfusion maps (p ≤ 0.048). Inter-reader agreement was (almost) perfect for all perfusion maps (kappa ≥ 0.927).

Conclusion

The results of this study indicate that TTD maps have the highest sensitivity for the detection of cerebral vasospasm and highest correlation with angiography regarding the severity of vasospasm.

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Abbreviations

ACA:

Anterior cerebral artery

AUC:

Areas under the Curve

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

DCI:

Delayed cerebral ischemias

MCA:

Middle cerebral artery

MTT:

Mean transit time

NCT:

Non-contrast CT

PCA:

Posterior cerebral artery

ROC-:

Receiver-operator-characteristics-

TCD:

Transcranial doppler ultrasound

TTD:

Time to drain

VPCT:

Volume perfusion CT

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany

    Ahmed E. Othman, Saif Afat, Omid Nikoubashman, Marguerite Müller, Marc A. Brockmann, Martin Wiesmann & Carolin Brockmann

  2. Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, 72076, Tübingen, Germany

    Ahmed E. Othman

  3. Department of Neurosurgery, RWTH Aachen University, Aachen, Germany

    Gerrit Alexander Schubert

  4. Department for Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen, Germany

    Georg Bier

  5. Department of Neuroradiology, University Hospital Mainz, Mainz, Germany

    Marc A. Brockmann

Authors
  1. Ahmed E. Othman
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  2. Saif Afat
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  3. Omid Nikoubashman
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  4. Marguerite Müller
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  5. Gerrit Alexander Schubert
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  6. Georg Bier
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  7. Marc A. Brockmann
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  8. Martin Wiesmann
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  9. Carolin Brockmann
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Corresponding author

Correspondence to Ahmed E. Othman.

Ethics declarations

We declare that all human studies have been approved by the local ethics committee at the RWTH Aachen University and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Due the retrospective nature of this study, informed consent was waived.

Conflict of Interest

We declare that we have no conflict of interest.

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Othman, A.E., Afat, S., Nikoubashman, O. et al. Volume perfusion CT imaging of cerebral vasospasm: diagnostic performance of different perfusion maps. Neuroradiology 58, 787–792 (2016). https://doi.org/10.1007/s00234-016-1695-9

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  • DOI: https://doi.org/10.1007/s00234-016-1695-9

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