Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management.
Vasospasm after subarachnoid hemorrhage: utility of perfusion CT and CT angiography on diagnosis and management.
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发表时间：
2006
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通讯作者：
M. Wintermark;N. Ko;W. Smith;Songling Liu;R. Higashida;W. Dillon
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作者：
M. Wintermark;N. Ko;W. Smith;Songling Liu;R. Higashida;W. Dillon
目的以传统数字减影血管造影（DSA）为金标准，评价CT灌注成像（PCT）结合CT血管造影（CTA）对血管痉挛的诊断和治疗价值。方法我们回顾性地确定了27例急性蛛网膜下腔出血患者，他们在12小时内接受了CTA/PCT、DSA和经颅多普勒（TCD）超声检查。对患者病历进行血管痉挛治疗审查。对CTA、PCT、TCD和DSA检查进行独立审查并量化血管痉挛。评价PCT阈值、CTA结果、非造影CT（NCT）低密度和TCD阈值在预测血管造影性血管痉挛和血管内治疗中的准确性、敏感性和特异性，以及阴性（NPV）和阳性预测值（PPV），将DSA视为金标准。结果27例患者共行CTA/PCT、TCD、DSA检查35次。11例患者共123个动脉区域表现出血管造影性血管痉挛。6例患者接受了血管内治疗。CTA定性评估和PCT衍生的平均通过时间（MTT）（阈值为6.4秒）是诊断血管痉挛的最准确（93%）组合，而单独考虑MTT是最敏感的参数（NPV，98.7%）。皮质局部脑血流量值</=39.3（mL x 100 g（-1）x min（-1））代表血管内治疗的最准确（94.8%）指标。PCT的PPV（89.9%）显著高于TCD（62.9%）。结论：CT检查结合CTA和PCT是疑似血管痉挛患者的一种准确的筛查试验。然而，有前途的，PCT的价值，选择最佳的管理策略，在这样的患者将需要进一步调查。
PURPOSE To evaluate the utility of perfusion CT (PCT) combined with CT angiography (CTA) for the diagnosis and management of vasospasm, by using conventional digital subtraction angiography (DSA) as the gold standard. METHODS We retrospectively identified 27 patients with acute subarachnoid hemorrhage who had undergone CTA/PCT, DSA, and transcranial Doppler (TCD) ultrasonography within a time interval of 12 hours of one another. The patients' charts were reviewed for treatment of vasospasm. CTA, PCT, TCD, and DSA examinations were independently reviewed and quantified for vasospasm. PCT thresholds, CTA findings, noncontrast CT (NCT) hypodensities, and TCD thresholds were evaluated for accuracy, sensitivity, and specificity, as well as for negative (NPV) and positive predictive values (PPV) in the prediction of angiographic vasospasm and endovascular treatment, considering DSA as the gold standard. RESULTS Thirty-five CTA/PCT, TCD, and DSA examinations were performed on these 27 patients. A total of 123 arterial territories in 11 patients demonstrated angiographic vasospasm. Six patients underwent endovascular therapy. CTA qualitative assessment and PCT-derived mean transit time (MTT) with a threshold at 6.4 seconds represented the most accurate (93%) combination for the diagnosis of vasospasm, whereas MTT considered alone represented the most sensitive parameter (NPV, 98.7%). A cortical regional cerebral blood flow value </=39.3 (mL x 100 g(-1)x min(-1)) represented the most accurate (94.8%) indicator for endovascular therapy. PCT had significantly higher PPV (89.9%) than TCD (62.9%). CONCLUSIONS A CT survey combining CTA and PCT represents an accurate screening test in patients with suspected vasospasm. However promising, the value of PCT for selecting the best management strategy in such patients will need to be further investigated.