Zerebrale Perfusion in der Akutphase nach aneurysmatischer Subarachnoidalblutung - Einsatz der CT-Perfusion für die Erfassung der frühen Hirnschädigung und der verzögerten zerebralen Ischämie
von Vesna PD Dr. Malinova
Datum der mündl. Prüfung:2020-07-20
Betreuer:Prof. Dr. Veit Rohde
EnglischAneurysmal subarachnoid hemorrhage (aSAH) is a devastating cerebrovascular disease associated with high morbidity and mortality due to early brain injury (EBI) and delayed complications like delayed cerebral ischemia (DCI). Imaging plays an important role for early detection of DCI to allow timely initiation of therapeutic measures and to prevent the occurrence of infarctions with permanent neurological deficits. While most previous publications focus on DCI, the role of EBI in the pathophysiology of DCI has been increasingly recognized in the past years. In this cumulative habilitation, the diagnostic value of computed tomography perfusion (CTP) for early prediction of DCI and for evaluation of EBI severity was evaluated and discussed. Cutoff-values for all CTP parameters were defined after performing quantitative analyses. Time to drain (TTD) was the CTP parameter with the highest discriminatory power for early prediction of DCI. Additionally, increased tissue permeability measured by CTP in the early phase after aSAH was associated with higher incidence of DCI. An elaborated imaging protocol including CTP allows an early prediction of DCI, which can be useful for guiding treatment decisions during the acute management of patients with aSAH at the intensive care unit.
Keywords: aneurysmal subarachnoid hemorrhage; computed tomography perfusion; delayed cerebral ischemia