Improving Clinical Outcomes Following Subarachnoid Hemmorhage Using CT Perfusion

脑血管痉挛不是很清楚，导致不确定的诊断和延误的治疗 动脉瘤性蛛网膜下腔出血(A-SAH)后。与以下疾病相关的临床结果很差 由于永久性神经功能缺陷、中风和死亡而导致的血管痉挛。高达81%的人被检测到中风 A-SAH患者，在美国每年影响21,000-33,000人。高达46%的人 长期认知障碍，影响功能状态和生活质量。因此，这种无序也是 与公共卫生保健成本和资源的巨大负担有关，主要与 住院、长期护理和残疾的间接经济成本。 我们的长期目标是通过实施CT来改善A-SAH患者的临床结果 灌注(CTP)作为一种手段(1)提供更早和更准确的血管痉挛诊断，以及(2)指导 有效的治疗策略。我们对这项研究建议的假设是，适当使用CTP将 通过提供更早和更准确的诊断来改善A-SAH患者的临床结局 血管痉挛。采用前瞻性队列研究设计，A-SAH患者将根据他们的 症状、经颅多普勒超声(TCD)、CT血管造影(CTA)、CTP和数字减影 血管造影术(DSA)检查。主要目标是确定CTP作为诊断的性能 评估血管痉挛的工具，通过这些特定的目的：(1)确定敏感性，特异性， CTP的阳性和阴性预测价值，(2)比较CTP与 症状、TCD、CTA和DSA，以及(3)确定最早提供 诊断。第二个目标是评价CTP在诊断血管痉挛中的作用。 具体目标：(4)评估CTP对诊断确定性和管理决策的影响，(5) 确定CTP对临床结果的影响，以及(6)进行成本-效果分析。 在我的学院有一个强大的指导计划，在哈佛大学有结构良好的教育课程 康奈尔大学公共卫生学院和威尔医学研究生院将大大 提高我的临床研究技能，并以我以前的研究经验为基础，发展成为一个 该领域的独立临床研究人员。

Cerebral vasospasm is not well understood leading to indeterminate diagnosis and delayed treatment following aneurysmal subarachnoid hemorrhage (A-SAH). There is poor clinical outcome associated with vasospasm due to permanent neurologic deficit, stroke and death. Stroke has been detected in up to 81% of A-SAH patients, affecting 21,000 - 33,000 persons each year in the United States. As many as 46% have long-term cognitive impairment, affecting functional status and quality of life. Thereby, this disorder is also associated with a substantial burden on public health care costs and resources, mostly related to hospitalization, long-term care and indirect economic costs of disability. Our long-term goal is to improve clinical outcomes of patients following A-SAH by implementing CT perfusion (CTP) as a means to (1) provide earlier and more accurate diagnosis of vasospasm, and (2) guide effective treatment strategies. Our hypothesis for this research proposal is that appropriate use of CTP will improve the clinical outcomes of A-SAH patients by providing earlier and more accurate diagnosis of vasospasm. Using a prospective cohort study design, A-SAH patients will be monitored according to their symptoms, transcranial Doppler ultrasound (TCD), CT angiography (CTA), CTP and digital subtraction angiograpghy (DSA) exams. The primary objective is to determine the performance of CTP as a diagnostic tool in the evaluation of vasospasm, by these specific aims: (1) To determine the sensitivity, specificity, positive and negative predictive values of CTP, (2) To compare sensitivity and specificity of CTP with symptoms, TCD, CTA and DSA, and (3) To identify the combination of modalities that provides the earliest diagnosis. The secondary objective is to evaluate the impact of CTP for diagnosis of vasospasm, with these specific aims: (4) To assess the effect of CTP on diagnostic certainty and management decision making, (5) To determine the effect.of CTP on clinical outcomes, and (6) To perform cost-effectiveness analysis. A strong mentoring program at my institution with a well-structure educational curriculum at the Harvard School of Public Health and Weill Graduate School of Medical Sciences of Cornell University will greatly enhance my clinical research skills and build on my prior research experience to develop into an independent clinical investigator in this field.