CT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
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Published on: February 17, 2013
D I A Mir1, A Gupta1, A Dunning2
1From the Departments of Radiology (D.I.A.M., A.G., L.P., C.L.R., P.C.S.).
Insights
Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (SAH) is a major concern. CT perfusion (CTP) is useful for identifying patients at risk of delayed cerebral ischemia, enabling earlier intervention.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Delayed cerebral ischemia (DCI) is a critical complication following aneurysmal subarachnoid hemorrhage (SAH), significantly impacting patient outcomes.
- Early identification of DCI is crucial for timely intervention and improved prognosis.
Purpose of the Study:
- To systematically review and evaluate the diagnostic utility of CT perfusion (CTP) in detecting DCI in patients with aneurysmal SAH.
Main Methods:
- A systematic review of cohort studies assessing CTP for DCI detection in aneurysmal SAH patients.
- Inclusion criteria encompassed studies defining DCI by clinical deterioration, imaging evidence of infarction, or functional disability.
- A random-effects meta-analysis was conducted to determine the association between positive CTP findings and DCI.
Main Results:
- Six cohort studies involving 345 patients were included.
- The pooled sensitivity and specificity of CTP for DCI detection were 0.84 and 0.77, respectively.
- Positive CTP results were associated with a 23-fold increased likelihood of DCI (OR 23.14).
Conclusions:
- Perfusion deficits identified by CTP are significant indicators of DCI in aneurysmal SAH.
- CTP can aid in identifying at-risk patients before the onset of infarction and neurological deficits.
Background And Purpose:
Delayed cerebral ischemia is a significant cause of morbidity and mortality after aneurysmal SAH, leading to poor outcomes. The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH.
Materials And Methods:
We conducted a systematic review evaluating studies that assessed CTP in patients with aneurysmal SAH for determining delayed cerebral ischemia. Studies using any of the following definitions of delayed cerebral ischemia were included in the systematic review: 1) new onset of clinical deterioration, 2) cerebral infarction identified on follow-up CT or MR imaging, and 3) functional disability. A random-effects meta-analysis was performed assessing the strength of association between a positive CTP result and delayed cerebral ischemia.
Results:
The systematic review identified 218 studies that met our screening criteria, of which 6 cohort studies met the inclusion criteria. These studies encompassed a total of 345 patients, with 155 (45%) of 345 patients classified as having delayed cerebral ischemia and 190 (55%) of 345 patients as not having delayed cerebral ischemia. Admission disease severity was comparable across all groups. Four cohort studies reported CTP test characteristics amenable to the meta-analysis. The weighted averages and ranges of the pooled sensitivity and specificity of CTP in the determination of delayed cerebral ischemia were 0.84 (0.7-0.95) and 0.77 (0.66-0.82), respectively. The pooled odds ratio of 23.14 (95% CI, 5.87-91.19) indicates that patients with aneurysmal SAH with positive CTP test results were approximately 23 times more likely to experience delayed cerebral ischemia compared with patients with negative CTP test results.
Conclusions:
Perfusion deficits on CTP are a significant finding in determining delayed cerebral ischemia in aneurysmal SAH. This may be helpful in identifying patients with delayed cerebral ischemia before development of infarction and neurologic deficits.
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