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Early CT perfusion changes and blood–brain barrier permeability after aneurysmal subarachnoid hemorrhage

  • Diagnostic Neuroradiology
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Abstract

Introduction

Early brain injury (EBI) can occur within 72 h of aneurysmal subarachnoid hemorrhage (aSAH). The objective of this study was to determine if there are differences in early CTP parameters (<72 h) with respect to delayed cerebral ischemia (DCI), cerebral infarction, and functional outcome.

Methods

We performed a prospective cohort study of aSAH patients admitted to a single tertiary care center. MTT, CBF and blood–brain barrier permeability (PS) were quantified with CTP within 72 h of aneurysm rupture. Primary outcomes were functional outcome by the Modified Rankin Scale (mRS) at 3 months and cerebral infarction. Secondary outcome was the development of DCI. Differences between early CTP parameters were determined with respect to primary and secondary outcomes.

Results

Fifty aSAH patients were included in the final analysis. MTT was significantly higher in patients who developed DCI (6.7 ± 1.2 vs 5.9 ± 1.0; p = 0.03) and cerebral infarction (7.0 ± 1.2 vs 5.9 ± 0.9; p = 0.007); however, no difference in MTT was found between patients with and without a poor outcome (mRS > 2). Early CBF and PS did not differ with respect to functional outcome, DCI, and cerebral infarction.

Conclusions

Elevated MTT within 72 h of aneurysm rupture is associated with DCI and cerebral infarction but not with long-term functional outcome. Blood–brain barrier permeability, as assessed by CT perfusion, was not associated with DCI or worse outcome in this cohort.

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Ethical standards and patient consent

We declare that all human and animal studies have been approved by the St. Michael’s Hospital Research Ethics Board and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

TL has a relationship with CT Perfusion software and receives research funding from GE Healthcare.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, University of Toronto, Room 3-077CC, 30 Bond St, Toronto, ON, M5B 1W8, Canada

    Amanda Murphy & Aditya Bharatha

  2. St. Michael’s Hospital, Toronto, Canada

    Airton Leonardo de Oliveira Manoel & Ekaterina Kouzmina

  3. Robarts Research Institute, London, Canada

    Kyle Burgers & Ting Lee

  4. Department of Neurosurgery, St. Michael’s Hospital, Toronto, Canada

    R. Loch Macdonald

Authors
  1. Amanda Murphy
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  2. Airton Leonardo de Oliveira Manoel
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  4. Ekaterina Kouzmina
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  5. Ting Lee
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  6. R. Loch Macdonald
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  7. Aditya Bharatha
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Correspondence to Amanda Murphy.

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Murphy, A., de Oliveira Manoel, A.L., Burgers, K. et al. Early CT perfusion changes and blood–brain barrier permeability after aneurysmal subarachnoid hemorrhage. Neuroradiology 57, 767–773 (2015). https://doi.org/10.1007/s00234-015-1529-1

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  • DOI: https://doi.org/10.1007/s00234-015-1529-1

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