Whole-brain CT perfusion on admission predicts delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

Purpose: The aim of this study is to prospectively evaluate whole-brain CT perfusion (CTP) on admission to predict delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: All 252 consecutive patients with aSAH enrolled in this study underwent one-stop whole-brain CTP scan within 24 h after aneurysm rupture. The qualitative and quantitative CTP parameters and clinical data were compared between patients with and without DCI. Diagnostic performance of clinical data and mean and lowest CTP parameters were evaluated by receiver-operating characteristic (ROC) analyses. Logistic regression analysis was employed to determine predictors of DCI. Results: The study evaluated 191 of 252 consecutive patients, 57 of whom (29.8%) developed DCI during hospitalization. Patients with diffused hypoperfusion had the highest incidence rate of DCI (43%, 46/107). Mean TMax produced the largest area under the curve of 0.726 (95% confidence interval [CI] 0.638-0.814), and a cutoff value of 2.240 s provided sensitivity of 73.7% and specificity of 71.6% for early prediction of developing DCI. Glasgow Coma Scale score (odds ratio [OR] = 0.716, 95% CI 0.565-0.908, P = 0.006), cerebral vasospasm (OR = 6.117, 95% CI 1.427-26.223, P = 0.015), hydrocephalus (OR = 3.795, 95% CI 1.327-10.858, P = 0.013), and qualitative CTP analysis (OR = 3.383, 95% CI 1.686-6.789, P = 0.001) were all significant independent predictors of DCI. Conclusions: Whole-brain CTP within 24 h of admission can qualitatively and quantitatively detect abnormal cerebral perfusion. It is possible to predict the risk of developing DCI after aSAH when the TMax value is larger than 2.240 s.