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Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage
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, threshold...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075209/ https://www.ncbi.nlm.nih.gov/pubmed/34970916 http://dx.doi.org/10.1161/JAHA.121.023828 |
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author | Allen, Jason W. Prater, Adam Kallas, Omar Abidi, Syed A. Howard, Brian M. Tong, Frank Agarwal, Shashank Yaghi, Shadi Dehkharghani, Seena |
author_facet | Allen, Jason W. Prater, Adam Kallas, Omar Abidi, Syed A. Howard, Brian M. Tong, Frank Agarwal, Shashank Yaghi, Shadi Dehkharghani, Seena |
author_sort | Allen, Jason W. |
collection | PubMed |
description | 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 (T (max)) 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 perfusion, and digital subtraction angiography (DSA) within 24 hours. T (max) 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 T (max) 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 T (max)>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 T (max)>6 seconds, and 12%/99% for CTA+T (max)>6 seconds. CONCLUSIONS: CTA and T (max) offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity. |
format | Online Article Text |
id | pubmed-9075209 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90752092022-05-10 Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage Allen, Jason W. Prater, Adam Kallas, Omar Abidi, Syed A. Howard, Brian M. Tong, Frank Agarwal, Shashank Yaghi, Shadi Dehkharghani, Seena J Am Heart Assoc Original Research 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 (T (max)) 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 perfusion, and digital subtraction angiography (DSA) within 24 hours. T (max) 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 T (max) 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 T (max)>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 T (max)>6 seconds, and 12%/99% for CTA+T (max)>6 seconds. CONCLUSIONS: CTA and T (max) offer high specificity for presence of vasospasm; their utility, even in combination, as screening tests is, however, limited by poor sensitivity. John Wiley and Sons Inc. 2021-12-31 /pmc/articles/PMC9075209/ /pubmed/34970916 http://dx.doi.org/10.1161/JAHA.121.023828 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Allen, Jason W. Prater, Adam Kallas, Omar Abidi, Syed A. Howard, Brian M. Tong, Frank Agarwal, Shashank Yaghi, Shadi Dehkharghani, Seena Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title | Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title_full | Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title_fullStr | Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title_full_unstemmed | Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title_short | Diagnostic Performance of Computed Tomography Angiography and Computed Tomography Perfusion Tissue Time‐to‐Maximum in Vasospasm Following Aneurysmal Subarachnoid Hemorrhage |
title_sort | diagnostic performance of computed tomography angiography and computed tomography perfusion tissue time‐to‐maximum in vasospasm following aneurysmal subarachnoid hemorrhage |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9075209/ https://www.ncbi.nlm.nih.gov/pubmed/34970916 http://dx.doi.org/10.1161/JAHA.121.023828 |
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