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CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality

  • Diagnostic Neuroradiology
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Abstract

Introduction

We retrospectively evaluated computed tomography angiography (CTA) and perfusion imaging (CTP) of patients with aneurysmal subarachnoid hemorrhage (SAH) for any correlation between degree of vasospasm and perfusion deficit.

Materials and methods

Sequentially performed CTP and CTA of 41 patients at least at the third day of postbleeding were reviewed for vasospasm and perfusion deficit throughout the anterior and middle cerebral arteries and corresponding territories. Vasospasm was noted comparing the contralateral normal ones or extradural components of the vessel itself and graded to negative, mild, moderate, and severe as luminal narrowing none, <25%, between 25% and 50%, and ≥50%, respectively. CTP abnormality was noted using cerebral blood flow and volume and mean transit time maps.

Results

Of 41 patients, 20 had no vasospasm; 15 had mild to moderate and six had severe vasospasm. Three of 20 patients with no vasospasm (15%), four of 15 patients with mild to moderate vasospasm (26%), and five of six patients with severe vasospasm (83%) had perfusion abnormality. Perfusion abnormalities noted were ischemia, infarction, and hyperperfusion. Perfusion abnormality without vasospasm was observed in the watershed areas and adjacent to sulcal clots.

Conclusion

In SAH patients, if there is a macrovascular vasospasm with luminal narrowing ≥50%, there is a high likelihood (83%) of perfusion abnormality in the territory of the vasospastic vessel. There may also be perfusion abnormality without macrovascular vasospasm in the watershed areas or in the vicinity of sulcal clots.

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Acknowledgements

We thank Abdullah Utku Senol, M.D. and Ozgur Tosun, Ph.D. for statistical advice. This study was supported by the Akdeniz University Scientific Research Projects Unit.

Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Akdeniz University, Arapsuyu, Antalya, 07070, Turkey

    Ayse Aralasmak, Can Ozkaynak & Timur Sindel

  2. Department of Neurosurgery, Akdeniz University, Antalya, Turkey

    Mahmut Akyuz & Recai Tuncer

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  1. Ayse Aralasmak
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  2. Mahmut Akyuz
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  3. Can Ozkaynak
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  4. Timur Sindel
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Correspondence to Ayse Aralasmak.

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Aralasmak, A., Akyuz, M., Ozkaynak, C. et al. CT angiography and perfusion imaging in patients with subarachnoid hemorrhage: correlation of vasospasm to perfusion abnormality. Neuroradiology 51, 85–93 (2009). https://doi.org/10.1007/s00234-008-0466-7

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  • DOI: https://doi.org/10.1007/s00234-008-0466-7

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