Artikel
Significance of Transcranial Doppler Sonography and CT Angiography in Vasospasm Monitoring of the Middle Cerebral Artery
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Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Posthemorrhagic cerebral vasospasm contributes to delayed neurological deterioration, a major cause of poor outcome after subarachnoid hemorrhage (SAH). Non-invasive diagnostics for vasospasm include blood flow velocities measured by transcranial Doppler sonography (TCD), assessment of vasospasm by CT angiography (CTA), and CT perfusion measurements (CTP). In the present study we assessed the correlation of TCD blood flow velocities and CTA vasospasm to examine whether CTA could be dispensible in patients with TCD exams of sufficient quality.
Methods: SAH patients with TCD vasospasm monitoring, CTA and CTP were identified retrospectively. Vessel diameters and vessel volumes of the M1 segments of the middle cerebral arteries were determined from CTA data using Amira software by following a standardized protocol. Vessel diameters and volumes were correlated with TCD blood flow velocities. Predictive values concerning presence of a perfusion deficit with consecutive indication for interventional vasospasm treatment were calculated for CTA and TCD.
Results: In 24 SAH patients, 84 CTA exams with corresponding CTP and TCD exam were identified. There was a negative correlation between vessel diameters and blood flow velocity (-0.59, p<0.001), and between vessel volume and blood flow velocity (-0.47, p<0.001) of the M1 segment. We found high negative predictive values concerning presence of a cerebral perfusion deficit for blood flow velocities >120 cm/s (100%) and CTA-derived vessel diameter < 2.5 mm (100%) or vessel volume < 7.5 µl/mm (97.6%), while positive predictive values were lower (25%, 20.5% and 14.5%).
Conclusion: Our data indicate similar conclusions from CTA and TCD concerning vasospasm of the M1 segment with indication for interventional treatment. Further studies are needed to confirm these results for other vascular segments.