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J Cereb Blood Flow Metab. 2018 Jun;38(6):973-979. doi: 10.1177/0271678X18768670. Epub 2018 Apr 3.

Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Author information

1
1 USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
2
4 Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
3
2 Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
4
3 Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Abstract

Blood-brain barrier (BBB) dysfunction has been implicated in ischemic risk following aneurysmal subarachnoid hemorrhage (aSAH), but never directly imaged. We prospectively examined whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). Global MR-derived BBB permeability ( Ktrans) was significantly higher in aSAH patients who subsequently developed DCI (five patients; 2.28 ± 0.09 × 10-3 min-1) compared to those who experienced radiographic vasospasm only (three patients; 1.85 ± 0.12 × 10-3 min-1; p < 0.05), or no vasospasm/ischemia (eight patients; 1.74 ± 0.07 × 10-3 min-1; p < 0.01). Ktrans > 2 × 10-3 min-1 predicted development of DCI (AUC = 0.98, 95% CI: 0.93-1). Global BBB dysfunction following aSAH is detectable with DCE-MR and predictive of ischemic risk.

KEYWORDS:

Delayed cerebral ischemia; aneurysm; blood–brain barrier; dynamic contrast-enhanced magnetic resonance imaging; subarachnoid hemorrhage

PMID:
29611451
PMCID:
PMC5998996
[Available on 2019-06-01]
DOI:
10.1177/0271678X18768670

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