Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time-to-Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

• Authors: Jason Allen, Emory University; Adam Prater, Emory University; Omar Kallas, Emory University; Syed A. Abidi, Emory University; Brian Howard, Emory University; Frank Tong, Emory University; Shashank Agarwal, New York University; Shadi Yaghi, New York University; Seena Dehkharghani, New York University
• Journal Title: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: Volume 11, Number 1
• Publisher: WILEY | 2022-01-04, Pages e023828-e023828
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1161/JAHA.121.023828
• Subjects: Health Sciences, Medicine and Surgery; Biology, Neuroscience
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; angiography; computed tomography angiography; digital subtraction; logistic models; retrospective studies; subarachnoid hemorrhage; CEREBRAL VASOSPASM; CT-PERFUSION; BLOOD-FLOW; STROKE; RELIABILITY; ACCURACY

Abstract

BACKGROUND: Vasospasm is a treatable cause of deterioration following aneurysmal subarachnoid hemorrhage. Cerebral computed tomography perfusion mean transit times have been proposed as a predictor of vasospasm but suffer from well-known technical limitations. We evaluated fully automated, thresholded time-to-maxima of the tissue residue function (Tmax ) for determination of vasospasm following aneurysmal subarachnoid hemorrhage. METHODS AND RESULTS: Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid hemorrhage undergoing computed tomography angiography (CTA), computed tomography per-fusion, and digital subtraction angiography (DSA) within 24 hours. Tmax at 4, 6, 8, and 10 s was generated using RAPID (iSchemaView Inc., Menlo Park, CA). Dual-reader CTA and computed tomography perfusion interpretations were compared for patients with and without vasospasm on DSA (DSA+ and DSA−). Logistic regression models were developed using CTA and Tmax as input predictors and DSA vasospasm as outcome in adjusted and unadjusted models. Imaging studies from all 31 subjects (mean age 47.3±11.1, 77% female, 65% with single aneurysm with mean size of 6.0±2.9 mm) were included. Vasospasm was identified in 42 segments on DSA and 59 segments on CTA, with significant associations across individual vessel segments (P<0.001). In adjusted analyses, DSA vasospasm was associated with CTA (odds ratio [OR], 2.43; 95% CI, 0.94–6.32; P=0.068) as well as territory-specific Tmax >6 seconds delays (OR, 3.57; 95% CI, 1.36–9.35; P=0.009). Sensitivity/ specificity for DSA vasospasm was 31%/91% for CTA, 26%/89% for Tmax >6 seconds, and 12%/99% for CTA+Tmax >6 seconds. CONCLUSIONS: CTA and Tmax offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity.