Flat-Detector CT to Quantify Response to Intra-Arterial Spasmolytic Therapy for Cerebral Vasospasm

Area of Science:

• Neuroimaging
• Interventional Neurology
• Radiology

Background:

• Cerebral vasospasm post-subarachnoid hemorrhage leads to significant morbidity and mortality.
• Current treatment involves intra-arterial spasmolytics, with effectiveness assessed subjectively via angiography.
• Objective quantitative assessment of treatment efficacy is needed.

Purpose of the Study:

• To evaluate the effectiveness of Flat-detector computed tomography (FDCT) in quantitatively measuring cerebral blood volume (CBV) changes after vasospasm treatment.
• To assess the utility of FDCT for objective evaluation of spasmolytic therapy.

Main Methods:

• Prospective study (October 2017 - June 2019) using Siemens Artis Q biplane FDCT.
• CBV was measured in specific brain regions before and after intra-arterial verapamil administration.
• Statistical analysis included the Wilcoxon signed-rank test.

Main Results:

• FDCT demonstrated significant increases in CBV post-verapamil treatment (average 59% temporal, 22% frontal, 24% parietal lobes; p=0.03).
• Observed decreases in mean arterial blood pressure and transcranial Doppler values post-treatment.
• The study included 6 patients with left hemisphere vasospasm.

Conclusions:

• FDCT can effectively quantify changes in cerebral blood volume following verapamil infusion for cerebral vasospasm.
• Quantitative assessment using FDCT provides objective reassurance of treatment improvement.