Entwicklung eines Perfusions-CT basierten Vasospasmus-Score zur Prädiktion des klinischen Langzeitergebnisses nach einer aneurysmatischen Subarachnoidalblutung

Development of a perfusion CT-based vasospasm score for the prediction of long-term clinical outcome after aneurysmal subarachnoid hemorrhage

by Ani Cuberi
Doctoral thesis
Date of Examination:2025-02-12
Date of issue:2025-01-31
Advisor:Prof. Dr. Daniel Behme
Referee:PD Dr. Ilko Maier
Referee:Prof. Dr. Margarete Schön
Persistent Address: http://dx.doi.org/10.53846/goediss-11043

 

 

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Abstract

English

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and morbidity rates. The high morbidity is primarily due to delayed neurological deficits, which are exacerbated by the occurrence of (micro)vasospasms. In this study, a CTP-based score was developed to predict long-term clinical outcomes. Additionally, it aims to serve as a diagnostic tool to identify patients who could benefit from interventional therapy for angiographic vasospasms. Methods/Results: Perfusion CT maps for cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were analyzed for 70 patients following aSAH using a score system for the territories of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and basal ganglia. The evaluation was conducted qualitatively and visually. In addition, clinical data such as the Hunt and Hess scale, Fisher scale, and modified Rankin scale, as well as imaging data such as the severity of vasospasms in CTA and DSA, were collected. The group with vasospasms showed significantly higher CBV and MTT values compared to the group without vasospasms, while the CBF score did not show a significant difference. In the interventional group, the score values for CBF, CBV, and MTT were significantly higher than in the non-intervention group, but the diagnostic accuracy was insufficient. Furthermore, significant differences in the degree of vessel narrowing in the CTA and TCD acceleration were observed between patients with vasospasms and those receiving interventions.The CTP score, the degree of vessel narrowing in CTA, and TCD acceleration, however, showed no predictive value for long-term outcomes and had limited sensitivity and specificity. Discussion: The significant differences in CBV and MTT scores in the vasospasm group suggest that microcirculatory impairment is already present. The higher CBF, CBV, and MTT scores in the interventional group indicate that patients with clinically relevant vasospasms can be identified. However, the diagnostic accuracy of the CTP score is not sufficient to make clinical decisions based solely on this information. Further investigations in a larger prospective study are needed.
Keywords: Aneurysmal subarachnoid hemorrhage (aSAH); Vasospasm; delayed cerebral ischemia; CT-Perfusion; Long-term clinical outcomes; Diagnostic tool; Interventional therapy
 
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