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Long-term impact of perfusion CT data after subarachnoid hemorrhage
Christian Mathys1, Daniel Martens, Dorothea C Reichelt
1Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany.
Insights
Perfusion computed tomography (PCT) can predict long-term outcomes in subarachnoid hemorrhage (SAH) patients. Elevated maximum mean transit time (MTTPEAK) on PCT indicates a higher risk of unfavorable outcomes.
Area of Science:
- Neuroradiology
- Neurology
- Medical Imaging
Background:
- Dynamic perfusion computed tomography (PCT) is a key diagnostic tool for detecting vasospasm post-subarachnoid hemorrhage (SAH).
- Assessing the prognostic value of PCT parameters in SAH patients is crucial for long-term outcome prediction.
Purpose of the Study:
- To evaluate the prognostic impact of perfusion computed tomography (PCT) parameters on the long-term outcomes of patients following subarachnoid hemorrhage (SAH).
Main Methods:
- Retrospective analysis of 312 patients with spontaneous subarachnoid hemorrhage (SAH).
- Assessment of long-term outcomes using the modified Rankin scale (mRS) via questionnaire at 23.06 ± 14.33 months post-ictus.
- Utilized perfusion computed tomography (PCT) data from the initial days after subarachnoid hemorrhage (SAH).
Main Results:
- Maximum mean transit time over several examinations per hemisphere (MTTPEAK) significantly correlated with long-term modified Rankin scale (mRS) scores (p ≤ 0.001, r = 0.422).
- MTTPEAK emerged as the second most significant predictor of long-term mRS, after initial hemorrhage severity.
- An MTTPEAK threshold of 3.98 s predicted unfavorable long-term outcomes (mRS ≥ 2) with 69.6% diagnostic accuracy.
Conclusions:
- Perfusion computed tomography (PCT) data are relevant for predicting the long-term clinical outcomes of subarachnoid hemorrhage (SAH) patients.
- Identifying high-risk patients aids in therapeutic decision-making and risk-benefit analysis for escalated treatment.
Introduction:
Dynamic perfusion computed tomography (PCT) has been established as a diagnostic instrument for the detection of vasospasm after subarachnoid hemorrhage (SAH). The purpose of this study was to assess the prognostic impact of PCT parameters after SAH on the long-term outcome of patients.
Methods:
Three hundred twelve patients were retrospectively interrogated with a questionnaire 23.06 ± 14.33 months after spontaneous subarachnoid hemorrhage. The modified Rankin scale (mRS) was determined, respectively. Scheduled PCT data sets from the first days after ictus were available for all patients.
Results:
The maximum mean transit time over several examinations per hemisphere (MTTPEAK) values were significantly correlated (p ≤ 0.001, r = 0.422) with the clinical long-term outcome (mRS). Corresponding to our linear regression analysis, MTTPEAK is the second most important regressor (behind clinical severity of the initial hemorrhage) for the prediction of long-term mRS. An MTTPEAK threshold of 3.98 s (identified by receiver operating characteristic analysis, area under the curve = 0.75) predicted an unfavorable long-term outcome (mRS ≥ 2) with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 67.3, 74.3, 84.5, 52.1, and 69.6 %, respectively.
Conclusion:
The presented data corroborate the relevance of PCT data for the clinical long-term outcome of SAH patients. By identification of patients who are at risk for a bad outcome and may need escalation of therapy, risk-benefit analysis is supported.
