Article
High inhomogeneity of early perfusion computerised tomography measurement – a predictor for poor outcome in patients with subarachnoid haemorrhage
Hohe Inhomogenität in der frühen Perfusions-Computertomographie – ein Prädiktor für ein schlechtes Therapieergebnis bei Patienten mit Subarachnoidalblutung
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Authors
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Björn B. Hofmann
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Igor Fischer
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Informatik und Statistik, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Christian Rubbert
- Heinrich-Heine-Universität Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf, Deutschland
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Jan Frederick Cornelius
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Sajjad Muhammad
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Daniel Hänggi
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
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Marcel Alexander Kamp
- Heinrich-Heine-Universität Düsseldorf, Abteilung für Neurochirurgie, Düsseldorf, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Impairment of tissue oxygenation caused by inhomogeneous micro- and macroscopic blood flow distribution, the so-called capillary transit time heterogeneity (CTH) was considered to contribute to delayed cerebral ischemia (DCI). Therefore, increased inhomogeneity of parenchymal perfusion can potentially contribute to the development of tissue hypoxia and DCI and ultimately may influence clinical outcome. Aim of the present study was to assess the value of inhomogeneity in early perfusion computerized tomography measurement (PCT) in predicting poor outcome.
Methods: 121 patients underwent an early PCT measurement within the first 24 hours after SAH. Inhomogeneity of the mean transit time (MTT) and the time to peak of the residue function (Tmax) in individual patients were correlated with the dichotomized functional outcome initially upon admission (good grade, World Federation of Neurosurgeons Scale (WFNS)° 1-3 vs. poor grade, WFNS°4-5) and at 3 months (unfavorable, Glasgow Outcome Scale (GOS) 1-3 vs. favorable, GOS 4-5). Inhomogeneity of cerebral perfusion was measured as the coefficient of variation (CV) of MTT and Tmax of a representative CAT-scan slice of the entire brain circumference.
Results: Upon admission, 64 patients (53%) were good and 57 patients (47%) poor neurological grade. After three months 46 patients (38%) had an unfavourable and 75 patients (62%) a favourable clinical outcome. The CV of MTT and Tmax did not correlate with the WFNS grade upon admission (CV of MTT: p = 0.9; CV of Tmax: p = 0.6). Also, the CV of MTT did not correlate with the GOS after three months. Contrary to this, CV of Tmax showed a highly significant correlation with the GOS after three months (p=0,002). A high inhomogeneity of Tmax values in the initial PCT scan correlated with a poor functional outcome.
Conclusion: Tmax-CV significantly correlated with the dichotomized clinical outcome of patients 3 months after discharge, whereby a high inhomogeneity of Tmax values in the initial PCT scan correlated with a poor functional outcome. The inhomogeneity of Tmax in early PCT therefore seems to be a potent predictor for the outcome in patients with subarachnoid hemorrhage.
