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INTRODUCTION: Cerebral vasospasm is the leading cause of morbidity and mortality in patients with aneurysmal subarachnoid haemorrhage (SAH) surviving the initial ictus. Commonly used techniques for vasospasm assessment are digital subtraction angiography and transcranial Doppler sonography. These techniques can reliably identify only the major vessel spasm and fail to estimate its haemodynamic significance. To overcome these issues and to enable comprehensive non-invasive assessment of vasospasm inside the interventional suite, a novel protocol involving measurement of parenchymal blood volume (PBV) using C-arm flat detector computed tomography (FDCT) was implemented. MATERIALS AND METHODS: Patients from the neuro-intensive treatment unit (ITU) with suspected vasospasm following aneurysmal SAH were scanned with a biplane C-arm angiography system using an intravenous contrast injection protocol. The PBV maps were generated using prototype software. Contemporaneous clinically indicated MR scan including the diffusion- and perfusion-weighted sequences was performed. C-arm PBV maps were compared against the MR perfusion maps. RESULTS: Distribution of haemodynamic impairment on C-arm PBV maps closely matched the pattern of abnormality on MR perfusion maps. On visual comparison between the two techniques, the extent of abnormality indicated PBV to be both cerebral blood flow and cerebral blood volume weighted. CONCLUSION: C-arm FDCT PBV measurements allow an objective assessment of the severity and localisation of cerebral hypoperfusion resulting from vasospasm. The technique has proved feasible and useful in very sick patients after aneurysmal SAH. The promise shown in this early study indicates that it deserves further evaluation both for post-SAH vasospasm and in other relevant clinical settings.

Original publication

DOI

10.1177/1591019915582376

Type

Journal article

Journal

Interv Neuroradiol

Publication Date

08/2015

Volume

21

Pages

479 - 489

Keywords

C-arm flat detector computed tomography, MR perfusion weighted imaging, Subarachnoid haemorrhage, parenchymal blood volume, vasospasm, Adult, Blood Volume, Blood Volume Determination, Cerebral Infarction, Cerebrovascular Circulation, Diffusion Magnetic Resonance Imaging, Fatal Outcome, Feasibility Studies, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Angiography, Male, Middle Aged, Neurosurgical Procedures, Subarachnoid Hemorrhage, Tomography, X-Ray Computed, Treatment Outcome, Vasospasm, Intracranial