Perfusion-CT assessment of blood-brain barrier permeability in patients with aneurysmal subarachnoid hemorrhage

Sirish Kishore, Nerissa Ko, Bruno P. Soares, Randall T. Higashida, Elizabeth Tong, Sumail Bhogal, Joerg Bredno, Su Chun Cheng, Max Wintermark

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The goal of this study was to determine which clinical and radiographic variables in patients with subarachnoid hemorrhage (SAH) are associated with in vivo blood-brain barrier permeability (BBBP) assessments obtained using perfusion-CT (PCT) technology. Methods: SAH patients with confirmed aneurysm etiology and with PCT and angiogram within 24. hours of each other were included, and relationships between clinical and imaging variables were analyzed using random-effects generalized linear models. Results: One thousand one hundred and sixty two vascular territories from 83 patients were evaluated in this study. The mean BBBP increased by severity of vasospasm on DSA, however, in multivariate analysis, only mean transit time (MTT), cerebral blood volume (CBV), and severity of hydrocephalus were significantly associated with BBBP. Increased BBBP was not associated with angiographic vasospasm severity in multivariate analysis. Conclusion: Perfusion-CT assessment of BBBP may serve as a unique and useful biomarker in conjunction with angiography, additional perfusion-CT parameters, and clinical assessments, especially in characterizing microvascular dysfunction, or even in targeting treatments. However, future prospective studies will be required to definitively establish its clinical utility in the care of SAH patients.

Original languageEnglish (US)
Pages (from-to)317-325
Number of pages9
JournalJournal of Neuroradiology
Volume39
Issue number5
DOIs
StatePublished - Dec 2012
Externally publishedYes

Keywords

  • Blood-brain barrier
  • Endothelial dysfunction
  • Perfusion-CT
  • Stroke
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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