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Cortical Blood Flow Insufficiency Scores with Computed Tomography Perfusion can Predict Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients: A Cohort Study

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Abstract

Background

The World Federation of Neurosurgical Societies (WFNS) scale is widely accepted for predicting outcomes for subarachnoid hemorrhage (SAH) patients. However, it is difficult to definitely predict outcomes for the most poor grade, WFNS grade 5. The present study aimed to investigate the prognostic ability of a novel classification using computed tomography perfusion (CTP) findings, called the cortical blood flow insufficiency (CBFI) scores.

Methods

CTP was performed on admission for aneurysmal SAH followed by radical treatments within 72 hours of onset. Twenty-four cerebral cortex regions of interest (ROIs) were defined. CBFI was defined as Tmax > 4 s in each ROI, and CBFI scores were calculated based on the total number of ROIs with CBFI. Using the optimal cutoff value based on receiver operating characteristics (ROC) analysis to predict patient functional outcomes, CBFI scores were divided into “high” or “low” CBFI scores. Patient functional outcomes at 90 days were categorized based on modified Rankin Scale scores (0–3, favorable group; 4–6 unfavorable group) (0–4, non-catastrophic group; 5–6, catastrophic group).

Results

Fifty-seven patients were included in this study, of whom 21 (36.8%) and 13 (22.8%) were in the unfavorable and the catastrophic groups, respectively. A factor predicting unfavorable and catastrophic outcomes was CBFI score cutoff value of 7 points (area under the curve, 0.73 and 0.81, respectively). In multivariable logistic regression analysis for unfavorable outcome, high CBFI scores (odds ratio (OR), 8.6; 95% confidence interval (CI), 1.1–65.4; P = 0.04) and WFNS grade 5 (OR, 30.0; 95% CI, 4.5–201.0; P < 0.001) remained as independent predictors, while for catastrophic outcome, high CBFI scores (OR, 25.3; 95% CI, 3.3–194.0; P = 0.002) and age (OR, 1.1; 95% CI, 1.0–1.2; P = 0.02) remained as independent predictors. Conversely, WFNS grade 5 was not an independent predictor of catastrophic outcomes (OR, 3.8; 95% CI, 0.6–24.0; P = 0.15). In high CBFI scores, the OR of the delayed cerebral ischemia (DCI) occurrence was 9.6 (95% CI, 1.5–61.4; P = 0.02) after adjusting for age.

Conclusion

High CBFI scores could predict unfavorable and catastrophic outcomes for aneurysmal SAH patients and DCI occurrence.

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Acknowledgments

The authors would like to thank Akio Katakata, Radiological Technologist, Fujita Health University School of Medicine for his invaluable support in the radiological study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan

    Jun Tanabe, Ichiro Nakahara, Shoji Matsumoto, Yoshio Suyama, Jun Morioka, Jumpei Oda, Akiko Hasebe, Takeya Suzuki, Sadayoshi Watanabe, Kenichiro Suyama & Tsuyoshi Ohta

  2. Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan

    Kazuhiro Murayama

  3. Department of Neurosurgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan

    Yuichi Hirose

  4. Department of Neurosurgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, Japan

    Tsuyoshi Ohta

Authors
  1. Jun Tanabe
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  2. Ichiro Nakahara
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  12. Kazuhiro Murayama
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Contributions

JT, IN, SM and YH contributed conception and design of the study; JT organized the database; JT, YS, JM, JO, AH, TS, SW and KS contributed to the acquisition and analysis of the data; JT wrote the first draft of the manuscript; JT, IN, SM, TO and KM wrote sections of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version.

Corresponding author

Correspondence to Jun Tanabe.

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The author declares that they have no conflict of interest.

Ethical Approval/Informed Consent

The study protocol was approved by the institutional ethics committee (approval HM19-130), and written informed consent for participation was waived for this study in accordance with the national legislation and the institutional requirements.

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Tanabe, J., Nakahara, I., Matsumoto, S. et al. Cortical Blood Flow Insufficiency Scores with Computed Tomography Perfusion can Predict Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients: A Cohort Study. Neurocrit Care 34, 946–955 (2021). https://doi.org/10.1007/s12028-020-01108-w

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