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Diagnosing delayed cerebral ischemia with different CT modalities in patients with subarachnoid hemorrhage with

Jan Willem Dankbaar1, Nicolien K de Rooij, Birgitta K Velthuis

  • 1Department of Radiology, Rudolf Magnus Institute for Neuroscience, University Medical Center, Utrecht, The Netherlands. j.w.dankbaar@umcutrecht.nl

Stroke
|September 19, 2009
PubMed

Insights

CT perfusion (CTP) is superior for diagnosing delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. This imaging technique aids in timely decision-making for patients experiencing clinical deterioration.

Area of Science:

  • Neuroradiology
  • Neurocritical Care
  • Cerebrovascular Diseases

Background:

  • Delayed cerebral ischemia (DCI) is a major complication following aneurysmal subarachnoid hemorrhage (aSAH), significantly impacting patient prognosis.
  • Early and accurate diagnosis of DCI is challenging, necessitating advanced imaging techniques for timely intervention.
  • Noncontrast CT (NCT), CT perfusion (CTP), and CT angiography (CTA) are evaluated for their diagnostic utility in suspected DCI.

Purpose of the Study:

  • To investigate the diagnostic performance of NCT, CTP, and CTA in identifying DCI.
  • To compare the effectiveness of these imaging modalities in patients with subarachnoid hemorrhage experiencing clinical deterioration.

Main Methods:

  • A prospective study enrolled 42 patients with aSAH and clinical deterioration suggestive of DCI.
  • Patients underwent NCT, CTP, and CTA scans upon admission and after clinical deterioration.
  • Diagnostic values (sensitivity, specificity, PPV, NPV) were calculated, with clinical diagnosis by neurologists serving as the gold standard.

Main Results:

  • CTP demonstrated higher sensitivity (0.84) and specificity (0.79) for DCI compared to NCT and CTA.
  • CTP also showed superior positive predictive value (0.88) and negative predictive value (0.73).
  • NCT and CTA had lower diagnostic accuracy, with CTA showing limited specificity (0.50).

Conclusions:

  • Qualitative assessment of CT perfusion (CTP) is diagnostically superior to NCT and CTA for DCI.
  • CTP can be a valuable tool for rapid decision-making and guiding treatment strategies in DCI patients.
  • These findings support the integration of CTP in the diagnostic workup of DCI following subarachnoid hemorrhage.
Abstract

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