Disturbance of CT perfusion within 24 hours after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH
Disturbance of CT perfusion within 24 hours after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH
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动脉瘤性 SAH 患者发病后 24 小时内 CT 灌注紊乱与 WFNS 分级相关，但与 DCI 的发展无关
DOI：
10.1007/s00701-017-3362-2
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发表时间：
2017
期刊：
影响因子：
2.4
通讯作者：
Kasuya H
中科院分区：
文献类型：
--
作者：
5.Takahashi Y;Sasahara A;Yamazaki K;Inazuka M;Kasuya H
背景：迟发性脑缺血（DCI）是动脉瘤性SAH （aSAH）的严重并发症，也是发病和死亡的主要原因。我们研究了发病后24小时内的CT灌注（CTP）数据是否与DCI及其预后相关。方法回顾性检查aSAH患者入院时的CT平扫、CTP和CTA。我们测量了平均传递时间（aMTT），并将其与年龄、WFNS分级、Fisher组、迟发性脑梗死、脑血管痉挛、改良Rankin量表（mRS）等临床因素进行比较。在皮质和两个基底神经节区域定量确定感兴趣区域（roi）。结果86例aSAH患者发病后24小时内11例出现迟发性脑缺血（DCI）， 28例出现脑血管痉挛。平均MTT与WFNS分级（p= 0.000）相关，与mRS （p= 0.128）、年龄（p= 0.759）、DCI （p= 0.669）、脑血管痉挛（p= 0.306）无关。另一方面，DCI与Fisher组（p= 0.0056）、mRS （p= 0.0052）和脑血管痉挛（p= 0.000）相关。此外，发病后24小时内的平均MTT在有和没有DCI的区域之间，或者在有和没有DCI的患者之间没有显著差异。结论发病后不久CT灌注紊乱与WFNS分级有关，但与DCI的发展无关。迟发性脑缺血可能仅由脑池血栓引起的脑血管痉挛引起，但与早期脑损伤无关。
BackgroundDelayed cerebral ischemia (DCI) is a serious complication following aneurysmal SAH (aSAH) and remains a leading cause of morbidity and mortality. We investigated whether data from CT perfusion (CTP) within 24 h after onset are associated with DCI and its outcome.MethodsWe retrospectively examined plain CT, CTP, and CT angiography (CTA) of aSAH patients on arrival. We measured the average mean transit time (aMTT) and compared it with several clinical factors, such as the age, WFNS grade, Fisher group, delayed cerebral infarction, cerebral vasospasm, and modified Rankin scale (mRS), at 1 month. Regions of interest (ROIs) were quantitatively determined in cortical and two basal ganglia areas.ResultsDelayed cerebral ischemia (DCI) developed in 11 patients and cerebral vasospasm in 28 patients out of a total of 86 aSAH patients scanned within 24 h after onset. The average MTT was correlated with the WFNS grade (p= 0.000), but not mRS (p= 0.128), age (p= 0.759), DCI (p= 0.669), or cerebral vasospasm (p= 0.306). On the other hand, DCI was associated with the Fisher group (p= 0.0056), mRS (p= 0.0052), and cerebral vasospasm (p= 0.000). Moreover, there were no significant differences in the average MTT within 24 h after onset between territories with and without DCI, or between patients with and without DCI.ConclusionsThe current findings suggest that disturbance of CT perfusion soon after the onset is associated with the WFNS grade but not with the development of DCI. Delayed cerebral ischemia may be solely caused by cerebral vasospasm due to a clot in the cistern, but not associated with early brain injury.