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

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

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.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood-Brain Barrier / diagnostic imaging*
  • Brain Ischemia / diagnostic imaging*
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Permeability
  • Predictive Value of Tests
  • Subarachnoid Hemorrhage / diagnostic imaging*
  • Vasospasm, Intracranial / diagnostic imaging*