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JOURNAL OF NEUROSURGICAL SCIENCES
Rivista di Neurochirurgia
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2016 Apr 28
One-shot 16 rows Computed Tomography Perfusion and Computed Tomography Angiography after subarachnoid haemorrhage in suspected vasospasm: role in selecting cerebral vasospasm for endovascular treatment
Alessandro STECCO 1, Francesco FABBIANO 2, Paola AMATUZZO 3, Martina QUAGLIOZZI 3, Eleonora SOLIGO 3, Ignazio DIVENUTO 1, Gabriele PANZARASA 4, Alessandro CARRIERO 2 ✉
1 Radiology Department, Neuroradiology Unit, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Novara, Italy; 2 U.O.C. Neuroradiologia Diagnostica e Terapeutica, Istituto Neurologico Mediterraneo I.R.C.C.S. Nuromed, Pozzilli, Isernia, Italy; 3 Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Novara, Italy; 4 Neurosurgery Department, "Maggiore della Carità" Hospital, Novara, Italy
BACKGROUND: The aim of the study was to evaluate the effectiveness and reliability of a combined computed tomography angiography (CTA) and computed tomography perfusion (CTP) approach in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage.
METHODS: 19 patients with clinical signs of arterial vasospasm and positive trans-cranial Doppler (TCD) were enrolled and underwent CTP. Mean time transit (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) values of 20 standardized ROI (regions of interest) were analysed, and CTA used to measure the gauge of 26 arterial ramifications. CTA measurements were compared with those taken upon hospitalization. Of the 19 patients, 11 were scheduled for digital subtraction angiography (DSA), performed less than 12 hours after execution of the CTA-CTP protocol. The results were compared with findings of DSA and/or clinical follow- up and CT or TCD.
RESULTS: CTA diagnosis of vasospasm was confirmed in all cases (100% sensitivity and 100% specificity), while CTP yielded 3 false negatives (70% sensitivity and 100% specificity). All patients sent for endovascular treatment had received diagnostic confirmation of vasospasm by angiography. CTP thresholds proved reliable in both diagnosis and indicating treatment.
CONCLUSIONS: Combined one-shot CT angiography and CT perfusion represents a valid alternative to DSA in the diagnosis and management of cerebral vasospasm.