Related Experiment Video
Updated: Mar 22, 2026
Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound
Published on: June 3, 2021
Multimodal non-invasive detection of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage
Andreas Ziebart1, Vera Marschal1, Andreas Pfnür1
1Department of Neurosurgery, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany; Department of Neurosurgery, Bezirkskrankenhaus Günzburg, University Medical Center Ulm, Lindenallee 2, 89312 Günzburg, Germany.
Insights
Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage is challenging to diagnose. CT perfusion mean transit time (MTT) showed the highest accuracy in detecting DCI events in this study.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Delayed cerebral ischemia (DCI) is a significant complication after aneurysmal subarachnoid hemorrhage (aSAH), leading to poor functional outcomes.
- Diagnosing DCI presents a challenge despite the use of various monitoring techniques.
- A standardized definition of DCI has been established, facilitating comparative studies.
Purpose of the Study:
- To compare the diagnostic performance of established monitoring methods for DCI in aSAH patients.
- To externally validate computed tomography (CT) perfusion time-to-maximum (TMAX) and objective pupillometry for DCI detection.
Main Methods:
- A cohort of 59 aSAH patients underwent multimodal monitoring for DCI between March 2023 and November 2024.
- Diagnostic performance was assessed for CT perfusion mean transit time (MTT), TMAX, CT angiography (CTA), transcranial Doppler ultrasonography (TCD), and dynamic infrared pupillometry (NPi).
- Area under the receiver operating characteristic curve (AUROC) was calculated for each modality concerning DCI events within 24 hours.
Main Results:
- CT perfusion MTT and TMAX demonstrated the highest AUROCs among non-invasive modalities (0.84 and 0.79, respectively).
- MTT exhibited the highest sensitivity (0.80) for DCI detection.
- TCD showed low sensitivity (0.23), while CTA and TCD had poor positive predictive values; pupillometry yielded no true positives.
Conclusions:
- CT perfusion MTT was the most diagnostically accurate modality evaluated for DCI in aSAH.
- Further research in larger, homogeneous cohorts is recommended to explore synergistic effects and optimize multimodal DCI diagnostic strategies involving MTT.
Background:
Delayed cerebral ischemia (DCI) remains a major determinant of poor functional outcome following aneurysmal subarachnoid hemorrhage (aSAH) and a diagnostic challenge, despite various monitoring modalities being employed in clinical practice. With a standardized definition of DCI now widely accepted, the present study aimed to compare the diagnostic performance of established monitoring methods and to provide external validation for computed tomography (CT) perfusion time-to-maximum (TMAX) and objective pupillometry.
Methods:
Data were derived from a cohort of patients with aSAH enrolled between March 2023 and November 2024 who underwent multimodal monitoring for DCI. Diagnostic performance of CT perfusion mean transit time (MTT), TMAX, CT angiography (CTA), transcranial Doppler ultrasonography (TCD), and dynamic infrared pupillometry (NPi) and areas under the receiver operating characteristic curve (AUROC) were calculated for each modality with respect to DCI events occurring within 24 hours.
Results:
We included 59 patients in the study who underwent multimodal non-invasive testing, identifying 25 DCI events. CTP MTT and TMAX had the highest AUROC (0.84; 95% CI, 0.75-0.93; 0.79, 95% CI 0.69-0.89) of non-invasive modalities and MTT had the highest sensitivity (0.80). TCD showed low sensitivity (0.23) and CTA and TCD showed poor positive predictive values (0.37 and 0.17). Pupillometry yielded no true positives.
Conclusions:
CT perfusion MTT demonstrated the highest diagnostic accuracy among all modalities evaluated. Future studies in larger, homogeneous cohorts are warranted to explore potential synergistic effects and optimize multimodal diagnostic strategies incorporating MTT.
