Flat‐Detector CT to Quantify Response to Intra‐Arterial Spasmolytic Therapy for Cerebral Vasospasm

Autor: Blair Apple, Camille K Milton, Kyle P. O'Connor, Bradley N. Bohnstedt, Allison E. Strickland
Rok vydání: 2019
Předmět:
Adult
Male
Middle Cerebral Artery
medicine.medical_specialty
Subarachnoid hemorrhage
Blood volume
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Cerebral vasospasm
medicine.artery
Internal medicine
medicine
Humans
Vasospasm
Intracranial
Radiology
Nuclear Medicine and imaging
Prospective Studies
medicine.diagnostic_test
business.industry
Angiography
Digital Subtraction
Parasympatholytics
Vasospasm
Digital subtraction angiography
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Cerebral Angiography
Transcranial Doppler
Treatment Outcome
cardiovascular system
Cardiology
Female
Neurology (clinical)
Internal carotid artery
Tomography
X-Ray Computed
business
Carotid Artery
Internal
030217 neurology & neurosurgery
circulatory and respiratory physiology
Cerebral angiography
Zdroj: Journal of Neuroimaging. 30:227-232
ISSN: 1552-6569
1051-2284
Popis: Background and purpose Cerebral vasospasm in the setting of subarachnoid hemorrhage causes morbidity and mortality due to delayed cerebral ischemia and permanent neurological deficits. Vasospasm treatment includes intra-arterial injection of a spasmolytic during cerebral angiography. To evaluate effectiveness, neurointerventionalists subjectively examine a posttreatment cerebral angiogram to determine change in vessel diameter or increase in microvascular perfusion. Flat-detector computed tomography (FDCT) scanner has the ability to quantitatively measure cerebral blood volume (CBV) within the parenchyma and detect a quantitative change following treatment. Methods This is a prospective study at a single institution between October 5, 2017 and June 3, 2019 that examines CBV studies from the Artis Q biplane (Siemens). Regions of interest were made in various territories to measure the CBV within the parenchyma before and after treatment with the spasmolytic verapamil. All instances of vasospasm involved vasculature within the left middle cerebral artery or internal carotid artery. The Wilcoxon signed-rank test was used to determine significance before and after treatment. Results Our cohort consists of 6 patients who underwent Digital Subtraction Angiography (DSA) and FDCT scans for cerebral vasospasm within the left hemisphere. After intra-arterial injection of 20 mg of verapamil, average increases in blood volume were 59%, 22%, and 24% for the temporal, frontal, and parietal lobes, respectively. P-values associated were .03. We also observed decrease in the mean arterial blood pressure and transcranial Doppler values after treatment. Conclusion In conclusion, FDCT could measure the effectiveness of a change in CBV from infusion of verapamil in the setting of cerebral vasospasm. The authors believe quantifying the change allows for reassurance of improvement of cerebral vasospasm.
Databáze: OpenAIRE
Externí odkaz: