1
|
Moser MM, Gramss L, Marik W, Weber M, Hirschmann D, Wang WT, Dodier P, Kasprian G, Bavinzski G, Rössler K, Hosmann A. Agreement between CT-Angiography and Digital Subtraction Angiography in Predicting Angiographic Vasospasm in Patients with Subarachnoid Hemorrhage. J Clin Med 2024; 13:3743. [PMID: 38999308 PMCID: PMC11242591 DOI: 10.3390/jcm13133743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Digital subtraction angiography (DSA) is the gold standard in the diagnosis of cerebral vasospasm, frequently observed after subarachnoid hemorrhage (SAH). However, less-invasive methods, such as computed tomography angiography (CTA), may be equally accurate. To further clarify comparability, this study evaluated the reliability of CTA in detecting cerebral vasospasm. Methods: This retrospective study included 51 patients with SAH who underwent both CTA and DSA within 24 h. The smallest diameter of the proximal cerebral arterial segments was measured in both modalities at admission and during the vasospasm period. The mean difference in diameter, the intraclass correlation coefficient (ICC) of CTA and DSA, the difference in grade of vasospasm and sensitivity, the specificity and the positive predictive value (PPV) for CTA were calculated. Results: A total of 872 arterial segments were investigated. At time of admission, arterial diameters were significantly smaller on CTA compared to DSA in all segments (-0.26 ± 0.12 mm; p < 0.05). At time of suspected vasospasm (day 9 ± 5), these differences remained significant only for the M1 segment (-0.18 ± 0.37 mm, p = 0.02), the P1 segment (-0.13 ± 0.24 mm, p = 0.04) and the basilar artery (-0.20 ± 0.37 mm, p = 0.0.04). The ICC between CTA and DSA was good (0.5-0.8). The sensitivity of CTA for predicting angiographic vasospasm was 99%, the specificity was 50% and the PPV was 92%. Conclusions: Arterial diameters measured on CTA may underestimate the arterial caliber observed in DSA; however, these absolute differences were minor. Importantly, vessel diameter alone does not fully reflect malperfusion, requiring additional imaging techniques such as CT perfusion.
Collapse
Affiliation(s)
- Miriam M Moser
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Leon Gramss
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Marik
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Weber
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Wei-Te Wang
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Philippe Dodier
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Kasprian
- Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerhard Bavinzski
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
2
|
Hakim M, Kawnayn G, Hassan MS, Uddin MN, Hasan M, Huq MR. Transcranial Doppler in the Detection of Cerebral Vasospasm After Subarachnoid Hemorrhage. Cureus 2024; 16:e61569. [PMID: 38962631 PMCID: PMC11221191 DOI: 10.7759/cureus.61569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Background Transcranial Doppler (TCD) is a simple, noninvasive, nonionizing, portable technique but not widely practiced to detect cerebral vasospasm after subarachnoid hemorrhage (SAH). Objective The aim of this study was to assess the performance of TCD in the detection of cerebral vasospasm in patients with SAH considering CT angiography (CTA) as a gold standard. Methods and material This cross-sectional study included 50 patients with acute SAH admitted to the National Institute of Neurosciences & Hospital (NINS & H), Dhaka, Bangladesh, from February to June 2021. The neurological status, severity of SAH, and initial CT findings were recorded. All patients were screened for cerebral vasospasm with TCD on the 4th, 7th, 10th, and 14th days after the event. Screening of cerebral vasospasm by CTA was done on the 14th day of the event or earlier if TCD suggested vasospasm. Results The mean age of the participants was 51.4 ±13.4 years (mean ± SD), and females were predominant (N=29, 58%). CTA detected cerebral vasospasm in 18 (36%) participants, but TCD could detect it in only 13 (26%) cases. Among the participants who had no vasospasm by CTA, all but one were also found to have no vasospasm by TCD. The agreement between TCD and CTA in detecting cerebral vasospasm was significant (p<0.001, κ=0.726). TCD shows good specificity (96.9%) and positive predictive value (92.8%), but sensitivity (72.2%) and negative predictive value (81.6%) were comparatively lower. Overall, the diagnostic accuracy of TCD in detecting cerebral vasospasm was 88%. Conclusions Although compared to CTA, TCD is a highly specific but less sensitive tool in detecting vasospasm, TCD remains a reliable screening tool for detecting vasospasm following SAH.
Collapse
Affiliation(s)
- Maliha Hakim
- Neurology, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | | | | | | | - Mashfiqul Hasan
- Endocrinology, Diabetes, and Metabolism, National Institute of Neurosciences and Hospital, Dhaka, BGD
| | | |
Collapse
|
3
|
Heitkamp C, Geest V, Tokareva B, Winkelmeier L, Faizy TD, Meyer L, Kyselyova AA, Meyer HS, Wentz R, Fiehler J, Bester M, Thaler C. CTA Supplemented by CTP Increases Interrater Reliability and Endovascular Treatment Use in Patients with Aneurysmal SAH. AJNR Am J Neuroradiol 2024; 45:284-290. [PMID: 38238090 DOI: 10.3174/ajnr.a8110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/02/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE Cerebral vasospasm is a common complication of aneurysmal SAH and remains a risk factor for delayed cerebral ischemia and poor outcome. The interrater reliability of CTA in combination with CTP has not been sufficiently studied. We aimed to investigate the reliability of CTA alone and in combination with CTP in the detection of cerebral vasospasm and the decision to initiate endovascular treatment. MATERIALS AND METHODS This is a retrospective single-center study including patients treated for aneurysmal SAH. Inclusion criteria were a baseline CTA and follow-up imaging including CTP due to suspected vasospasm. Three neuroradiologists were asked to grade 15 intracranial arterial segments in 71 cases using a tripartite scale (no, mild <50%, or severe >50% vasospasm). Raters further evaluated whether endovascular treatment should be indicated. The ratings were performed in 2 stages with a minimum interval of 6 weeks. The first rating included only CTA images, whereas the second rating additionally encompassed CTP images. All raters were blinded to any clinical information of the patients. RESULTS Interrater reliability for per-segment analysis of vessels was highly variable (κ = 0.16-0.61). We observed a tendency toward higher interrater reliability in proximal vessel segments, except for the ICA. CTP did not improve the reliability for the per-segment analysis. When focusing on senior raters, the addition of CTP images resulted in higher interrater reliability for severe vasospasm (κ = 0.28; 95% CI, 0.10-0.46 versus κ = 0.46; 95% CI, 0.26-0.66) and subsequently higher concordance (κ = 0.23; 95% CI, -0.01-0.46 versus κ = 0.73; 95% CI, 0.55-0.91) for the decision of whether endovascular treatment was indicated. CONCLUSIONS CTA alone offers only low interrater reliability in the graduation of cerebral vasospasm. However, using CTA in combination with CTP might help, especially senior neuroradiologists, to increase the interrater reliability to identify severe vasospasm following aneurysmal SAH and to increase the reliability regarding endovascular treatment decisions.
Collapse
Affiliation(s)
- Christian Heitkamp
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vincent Geest
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bogdana Tokareva
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laurens Winkelmeier
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna A Kyselyova
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno S Meyer
- Department of Neurosurgery (H.S.M.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rabea Wentz
- Department of Diagnostic and Interventional Radiology (R.W.), Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Jens Fiehler
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Thaler
- From the Department of Neuroradiology (C.H., V.G., B.T., L.W., T.D.F., L.M., A.A.K., J.F., M.B., C.T.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Trofimov AO, Trofimova SY, Agarkova DI, Trofimova KA, Semyachkina-Glushkovskaya O, Atochin D, Bragina OA, Nemoto EM, Bragin DE. Intracranial dynamics biomarkers at traumatic cerebral vasospasm. BRAIN & SPINE 2023; 4:102727. [PMID: 38178989 PMCID: PMC10765010 DOI: 10.1016/j.bas.2023.102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Introduction Patients who suffer severe traumatic brain injury (sTBI) and cerebral vasospasm (CVS) frequently have posttraumatic cerebral ischemia (PCI). The research question was to study changes in cerebral microcirculatory bed parameters in sTBI patients with CVS and with or without PCI. Material and methods A total of 136 severe TBI patients were recruited in the study. All patients underwent perfusion computed tomography, intracranial pressure monitoring, and transcranial Doppler. The levels of cerebrovascular resistance (CVR), cerebral arterial compliance (CAC), cerebrovascular time constant (CTC), and critical closing pressure (CCP) were measured using the neuromonitoring complex. Statistical analysis was performed using parametric and nonparametric methods and factor analysis. The patients were dichotomized into PCI-positive (n = 114) and PCI-negative (n = 22) groups. Data are presented as mean values (standard deviations). Results CVR was significantly increased, whereas CAC, CTC, and CCP were significantly decreased in sTBI patients with CVS and PCI development (p < 0.05). Factor analyses revealed that all studied microcirculatory bed parameters were significantly associated with the development of PCI (p < 0.05). Discussion and conclusion The changes in all studied microcirculatory bed parameters in TBI patients with CVS were significantly associated with PCI development, which enables us to regard them as the biomarkers of CVS and PCI development. The causes of the described microcirculatory bed parameters changes might include complex (cytotoxic and vasogenic) brain edema development, regional microvascular spasm, and dysfunction of pericytes. A further prospective study is warranted.
Collapse
Affiliation(s)
- Alexey O. Trofimov
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Svetlana Y. Trofimova
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Darya I. Agarkova
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Kseniia A. Trofimova
- Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | | | - Dmitriy Atochin
- Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Olga A. Bragina
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA
| | - Edwin M. Nemoto
- Department of Neurology, University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Denis E. Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
5
|
Quintas-Neves M. The Complementary Role of CT Perfusion and Transcranial Doppler in the Assessment of Delayed Cerebral Ischemia after Aneurysmal SAH. AJNR Am J Neuroradiol 2022; 43:E3. [PMID: 35241424 PMCID: PMC8910813 DOI: 10.3174/ajnr.a7417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Raymond J, Létourneau-Guillon L, Darsaut TE, Findlay JM, Chow MM, Keough MB, Chan AM, Farzin B, Gevry G, Chagnon M, Zehr J. Reply. AJNR Am J Neuroradiol 2022; 43:E4. [PMID: 35241423 PMCID: PMC8910809 DOI: 10.3174/ajnr.a7454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J. Raymond
- Department of Radiology, Neuroradiology Service Centre Hospitalier de l’Université de Montréal (CHUM), Montreal Quebec, CanadaCHUM Research Centre, MontrealQuebec, Canada
| | - L. Létourneau-Guillon
- Department of Radiology, Neuroradiology Service Centre Hospitalier de l’Université de Montréal (CHUM), Montreal Quebec, CanadaCHUM Research Centre, MontrealQuebec, Canada
| | - T E Darsaut
- Department of Surgery, Division of Neurosurgery University of Alberta hospital, Mackenzie Health Sciences Center, EdmontonAlberta, Canada
| | - J M Findlay
- Department of Surgery, Division of Neurosurgery University of Alberta hospital, Mackenzie Health Sciences Center, EdmontonAlberta, Canada
| | - M M Chow
- Department of Surgery, Division of Neurosurgery University of Alberta hospital, Mackenzie Health Sciences Center, EdmontonAlberta, Canada
| | - M B Keough
- Department of Surgery, Division of Neurosurgery University of Alberta hospital, Mackenzie Health Sciences Center, EdmontonAlberta, Canada
| | - A M Chan
- Department of Surgery, Division of Neurosurgery University of Alberta hospital, Mackenzie Health Sciences Center, EdmontonAlberta, Canada
| | | | - G Gevry
- CHUM Research Centre, MontrealQuebec, Canada
| | - M Chagnon
- Department of Mathematics and Statistics Université de Montréal, Montreal Quebec, Canada
| | - J Zehr
- Department of Mathematics and Statistics Université de Montréal, Montreal Quebec, Canada
| |
Collapse
|
7
|
Angiographic vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage: Moving from theoretical to practical research pertinent to neurosurgical care. Neurochirurgie 2021; 68:363-366. [PMID: 34844761 DOI: 10.1016/j.neuchi.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia (DCI) and angiographic vasospasm following subarachnoid hemorrhage (SAH) have been associated for more than 50years. We aimed to examine whether the knowledge gained by theoretical research on vasospasm has actually translated into better patient outcomes in practice. METHODS This is a narrative review of the concept of vasospasm as a cause of DCI after SAH. We discuss recent studies that have assessed the accuracy and reliability of the diagnostic tests (transcranial Doppler ultrasound [TCD], CT angiography, and catheter angiography), which are used to identify SAH patients at-risk of DCI. RESULTS Both the diagnostic accuracy of TCD and the reliability of CT angiography to identify patients in severe vasospasm are poor. For the gold standard catheter angiography, the repeatability of the diagnosis of vasospasm, made by multiple raters, is only fair. Interventions on angiographic vasospasm have never been proven to improve patient outcomes. A pragmatic trial integrating the meaning of the diagnosis of vasospasm into a study protocol that assesses the value of endovascular interventions in the prevention of DCI after SAH seems to be in order. Such a trial could provide a pragmatic definition of clinically meaningful vasospasm. CONCLUSION We must move beyond research conceived as an enterprise aiming to acquire theoretical knowledge to one where research is integrated into clinical practice to improve clinical outcomes in real time.
Collapse
|