Whole-Brain Permeability Analysis on Admission Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage |
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| Affiliation: | 1. Department of Radiology, Yijishan Hospital of Wannan Medical College, China;2. Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, China;1. John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, United States;2. Department of Kinesiology and Health Sciences, College of Humanities and Science, Virginia Commonwealth University and the Division of Cardiology, VCU Pauley Heart Center, Department of Internal Medicine, VCU, Richmond, Virginia, United States;3. Division of Cardiovascular Medicine, Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States;1. School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador;2. Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA;3. Community Center, The Atahualpa Project, Atahualpa, Ecuador;4. Department of Psychiatry, Mount Sinai Morningside, New York, NY, USA;5. Renaissance School of Medicine, Stony Brook University, New York, NY, USA;1. Department of Neurology, Kentucky Neuroscience Institute;2. Department of Pathology & Laboratory Medicine, University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA;3. Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA;4. Harvard Medical School, Boston, MA, USA;5. Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.;6. Department of Surgery and Cancer, Imperial College London, London, UK;7. Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK;8. Department of Surgery, Oxford University Hospitals NHS Trust, Oxford, UK;9. Department of Neurology, Hackensack University Medical Center, Hackensack, USA;10. National Heart and Lung Institute, Imperial College London, UK;11. Department of Cardiology, Kings College of London, British Heart Foundation Centre of Research Excellence, London, UK;12. Division of Pulmonary and Critical Care, Brigham and Women''s Hospital, Boston, MA, USA;13. Division of Neurology, Mount Auburn Hospital, Cambridge, MA, USA;1. Department of Neurology, Binzhou Central Hospital, Binzhou, Shandong 251700, China;2. Third Inpatient Ward of Department of Neurology, Gaotang County People''s Hospital, Liaocheng, Shandong 252800, China;3. ICU, Binzhou People''s Hospital, Binzhou, Shandong 256600, China;4. Department of Geriatrics, Dazhou Central Hospital, Dazhou, Sichuan 635000, China;1. Laboratory of Clinical Applied Anatomy, Department of Human Anatomy, School of Basic Medical Sciences, Fujian Medical University, No.1 Xuefu North Road, Fuzhou, Fujian 350122, China;2. Key Laboratory of Brain Aging and Neurodegenerative Diseases of Fujian Province, Fuzhou 350122, China;3. Public Technology Service Center, Fujian Medical University, Fuzhou 350122, China |
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| Abstract: | PurposeTo evaluate the changes of blood-brain barrier permeability (BBBP) after aneurysmal subarachnoid hemorrhage (aSAH) and find out whether BBBP within 24 h after onset can further improve prediction of delayed cerebral ischemia (DCI).MethodsCT perfusion (CTP) was performed within 24 h after onset and in the DCI time window (DCITW). Whole brain average values of flow extraction product (mKtrans), qualitative and quantitative CTP parameters, and clinical data were compared between DCI and non-DCI groups. The changes of mKtrans were analysed using a Paired t test. Multivariate logistic regression analysis and ROC analyses were performed to identify predictors of DCI and evaluate the predictive performance.ResultsOne hundred and forty of 179 consecutive patients were included, 45 of whom (32%) developed DCI. mKtrans was higher in the DCI group both on admission and in the DCITW (P<0.001). mKtrans decreased significantly in the non-DCI group (P=0.003), but not in DCI group (P=0.285). Multivariate logistic regression analysis showed that mKtrans (OR=1.07, 95%CI: 1.03-1.11, P<0.001), World Federation of Neurosurgery Scale (OR=6.73, 95%CI: 1.09-41.41, P=0.040), Hunt-Hess grade (OR=0.16, 95%CI: 0.02-1.19, P=0.073), modified Fisher Score (OR=3.74, 95%CI: 1.30-10.75, P=0.014), and qualitative CTP (OR=4.31, 95%CI: 1.49-12.47, P=0.007) were independent predictors of DCI. The model with Ktrans produced a larger AUC of 0.88 (95%CI: 0.81-0.95), with corresponding sensitivity and specificity of 84% and 86%, respectively.ConclusionBBBP measurement within 24 h after onset can improve the prediction of DCI. Early moderate BBB disruption may be reversible, whereas severe BBBP disruption indicates the risk of DCI. |
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| Keywords: | aSAH" },{" #name" :" keyword" ," $" :{" id" :" pc_egjYaoF32D" }," $$" :[{" #name" :" text" ," _" :" aneurysmal subarachnoid hemorrhage BB" },{" #name" :" keyword" ," $" :{" id" :" pc_HIlVhUXkVc" }," $$" :[{" #name" :" text" ," _" :" blood-brain barrier BBBP" },{" #name" :" keyword" ," $" :{" id" :" pc_jrmW5uR3pk" }," $$" :[{" #name" :" text" ," _" :" blood-brain barrier permeability CBF" },{" #name" :" keyword" ," $" :{" id" :" pc_IEZHoheV0g" }," $$" :[{" #name" :" text" ," _" :" cerebral blood flow CI" },{" #name" :" keyword" ," $" :{" id" :" pc_9xgWa4HKUu" }," $$" :[{" #name" :" text" ," _" :" confidence interval CTP" },{" #name" :" keyword" ," $" :{" id" :" pc_lHwhWbfzT8" }," $$" :[{" #name" :" text" ," _" :" CT perfusion DCI" },{" #name" :" keyword" ," $" :{" id" :" pc_EowPGACFN6" }," $$" :[{" #name" :" text" ," _" :" delayed cerebral ischemia DCITW" },{" #name" :" keyword" ," $" :{" id" :" pc_qRdoW0ICTJ" }," $$" :[{" #name" :" text" ," _" :" DCI time window H-H" },{" #name" :" keyword" ," $" :{" id" :" pc_DEvHVjzn0X" }," $$" :[{" #name" :" text" ," _" :" Hunt-Hess grade flow extraction product mFS" },{" #name" :" keyword" ," $" :{" id" :" pc_uZCbjlIC6d" }," $$" :[{" #name" :" text" ," _" :" modified Fisher Score SEBES" },{" #name" :" keyword" ," $" :{" id" :" pc_V0sxKu0NJB" }," $$" :[{" #name" :" text" ," _" :" Subarachnoid Hemorrhage Early Brain Edema Score TMax" },{" #name" :" keyword" ," $" :{" id" :" pc_1W8PFsZL76" }," $$" :[{" #name" :" text" ," _" :" transit time to the center of the impulse response function TTD" },{" #name" :" keyword" ," $" :{" id" :" pc_VO3Gvh526I" }," $$" :[{" #name" :" text" ," _" :" time to drain WFNS" },{" #name" :" keyword" ," $" :{" id" :" pc_a8oueYSXuR" }," $$" :[{" #name" :" text" ," _" :" World Federation of Neurosurgery scale |
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