Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage
Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare t...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2012-01-01
|
| Series: | Radiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2012/231206 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832548076984729600 |
|---|---|
| author | Ekkehard Kunze Mirko Pham Furat Raslan Christian Stetter Jin-Yul Lee Laszlo Solymosi Ralf-Ingo Ernestus Giles Hamilton Vince Thomas Westermaier |
| author_facet | Ekkehard Kunze Mirko Pham Furat Raslan Christian Stetter Jin-Yul Lee Laszlo Solymosi Ralf-Ingo Ernestus Giles Hamilton Vince Thomas Westermaier |
| author_sort | Ekkehard Kunze |
| collection | DOAJ |
| description | Background. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH. |
| format | Article |
| id | doaj-art-aea80de2d45142fb9da3168721071233 |
| institution | Kabale University |
| issn | 2090-1941 2090-195X |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Radiology Research and Practice |
| spelling | doaj-art-aea80de2d45142fb9da31687210712332025-02-03T06:42:16ZengWileyRadiology Research and Practice2090-19412090-195X2012-01-01201210.1155/2012/231206231206Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid HemorrhageEkkehard Kunze0Mirko Pham1Furat Raslan2Christian Stetter3Jin-Yul Lee4Laszlo Solymosi5Ralf-Ingo Ernestus6Giles Hamilton Vince7Thomas Westermaier8Department of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neuroradiology, Universitt Würzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyDepartment of Neurosurgery, University of Wuerzburg, Josef-Schneider-Str. 11, 97080 Wuerzburg, GermanyBackground. If detected in time, delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may be treated by balloon angioplasty or chemical vasospasmolysis in order to enhance cerebral blood flow (CBF) and protect the brain from ischemic damage. This study was conceived to compare the diagnostic accuracy of detailed neurological examination, Transcranial Doppler Sonography (TCD), and Perfusion-CT (PCT) to detect angiographic vasospasm. Methods. The sensitivity, specificity, positive and negative predictive values of delayed ischemic neurological deterioration (DIND), pathological findings on PCT-maps, and accelerations of the mean flow velocity (MVF) were calculated. Results. The accuracy of DIND to predict angiographic vasospasm was 0.88. An acceleration of MFV in TCD (>140 cm/s) had an accuracy of 0.64, positive PCT-findings of 0.69 with a higher sensitivity, and negative predictive value than TCD. Interpretation. Neurological assessment at close intervals is the most sensitive and specific parameter for cerebral vasospasm. PCT has a higher accuracy, sensitivity and negative predictive value than TCD. If detailed neurological evaluation is possible, it should be the leading parameter in the management and treatment decisions. If patients are not amenable to detailed neurological examination, PCT at regular intervals is a helpful tool to diagnose secondary vasospasm after aneurysmal SAH.http://dx.doi.org/10.1155/2012/231206 |
| spellingShingle | Ekkehard Kunze Mirko Pham Furat Raslan Christian Stetter Jin-Yul Lee Laszlo Solymosi Ralf-Ingo Ernestus Giles Hamilton Vince Thomas Westermaier Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage Radiology Research and Practice |
| title | Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
| title_full | Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
| title_fullStr | Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
| title_full_unstemmed | Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
| title_short | Value of Perfusion CT, Transcranial Doppler Sonography, and Neurological Examination to Detect Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage |
| title_sort | value of perfusion ct transcranial doppler sonography and neurological examination to detect delayed vasospasm after aneurysmal subarachnoid hemorrhage |
| url | http://dx.doi.org/10.1155/2012/231206 |
| work_keys_str_mv | AT ekkehardkunze valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT mirkopham valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT furatraslan valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT christianstetter valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT jinyullee valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT laszlosolymosi valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT ralfingoernestus valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT gileshamiltonvince valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage AT thomaswestermaier valueofperfusioncttranscranialdopplersonographyandneurologicalexaminationtodetectdelayedvasospasmafteraneurysmalsubarachnoidhemorrhage |