Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study
Background Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds...
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| Veröffentlicht in: | Egyptian Journal of Radiology and Nuclear Medicine 2020-04, Vol.51 (1), p.61-10, Article 61 |
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| container_title | Egyptian Journal of Radiology and Nuclear Medicine |
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| creator | Abdel-Tawab, Mohamed Hasan, Afaf A. Ahmed, Mohamed A. Seif, Hany M. A. Yousif, Hazem A. |
| description | Background
Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds.
This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction.
Results
Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s.
Conclusion
MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients. |
| doi_str_mv | 10.1186/s43055-020-00180-8 |
| format | Article |
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Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds.
This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction.
Results
Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s.
Conclusion
MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients.</description><identifier>ISSN: 2090-4762</identifier><identifier>ISSN: 0378-603X</identifier><identifier>EISSN: 2090-4762</identifier><identifier>DOI: 10.1186/s43055-020-00180-8</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aneurysms ; Care and treatment ; Cerebral ischemia ; Clinical deterioration ; Cohort analysis ; Consciousness ; Contrast agents ; CT imaging ; CT perfusion ; Delayed cerebral ischemia ; Diabetes ; Fisher scale ; Gender ; Hematoma ; Hemorrhage ; Hunt and Hess scale ; Hypertension ; Imaging ; Ischemia ; Medical prognosis ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Nuclear Medicine ; Patients ; Prognosis ; Radiology ; Software ; Statistical analysis ; Stroke ; Stroke (Disease) ; Subarachnoid hemorrhage ; Vasospasm</subject><ispartof>Egyptian Journal of Radiology and Nuclear Medicine, 2020-04, Vol.51 (1), p.61-10, Article 61</ispartof><rights>The Author(s) 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c496t-984ecba2c2eaa3f63f361d99a7b5d0fb33385b1514b769eb88c64ba8ba013ce93</citedby><cites>FETCH-LOGICAL-c496t-984ecba2c2eaa3f63f361d99a7b5d0fb33385b1514b769eb88c64ba8ba013ce93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,861,27905,27906</link.rule.ids></links><search><creatorcontrib>Abdel-Tawab, Mohamed</creatorcontrib><creatorcontrib>Hasan, Afaf A.</creatorcontrib><creatorcontrib>Ahmed, Mohamed A.</creatorcontrib><creatorcontrib>Seif, Hany M. A.</creatorcontrib><creatorcontrib>Yousif, Hazem A.</creatorcontrib><title>Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study</title><title>Egyptian Journal of Radiology and Nuclear Medicine</title><addtitle>Egypt J Radiol Nucl Med</addtitle><description>Background
Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds.
This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction.
Results
Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s.
Conclusion
MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients.</description><subject>Aneurysms</subject><subject>Care and treatment</subject><subject>Cerebral ischemia</subject><subject>Clinical deterioration</subject><subject>Cohort analysis</subject><subject>Consciousness</subject><subject>Contrast agents</subject><subject>CT imaging</subject><subject>CT perfusion</subject><subject>Delayed cerebral ischemia</subject><subject>Diabetes</subject><subject>Fisher scale</subject><subject>Gender</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Hunt and Hess scale</subject><subject>Hypertension</subject><subject>Imaging</subject><subject>Ischemia</subject><subject>Medical prognosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Nuclear Medicine</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Radiology</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Stroke (Disease)</subject><subject>Subarachnoid hemorrhage</subject><subject>Vasospasm</subject><issn>2090-4762</issn><issn>0378-603X</issn><issn>2090-4762</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNp9Uk2LFDEUbETBZd0_4Cngudd8dKcTb8vgx8KCHtZzeEleejL0dMakW5ibP93strgKYnJIeKmqvFdU07xm9JoxJd-WTtC-bymnLaVM0VY9ay441bTtBsmf_3F_2VyVcqB1dRUpu4vmx5ecxjmVJToSwC0pF5IC8TjBGT1xmNFmmEgsbo_HCATCgpmU1UIGt59T9KQ-pJz3MCKJs5tWH-eR7O7JCXNYS0zzOwLklFM5oVvidyQu7VNeSFlWf37VvAgwFbz6dV42Xz-8v999au8-f7zd3dy1rtNyabXq0FngjiOACFIEIZnXGgbbexqsEEL1lvWss4PUaJVysrOgLFAmHGpx2dxuuj7BwZxyPEI-mwTRPBZSHg3k6sKEhgaoQtp1tv7qvbCcOe3Qow6CDSiq1ptNqw71bcWymENa81zbN1wxLhWjnD-hRqiicQ5pqZYdq5PmRirKBk11X1HX_0DV7avdLs0YYq3_ReAbwVVHS8bwexhGzUMezJYHU_NgHvNgVCWJjVQqeB4xP3X8H9ZPbPu5MA</recordid><startdate>20200421</startdate><enddate>20200421</enddate><creator>Abdel-Tawab, Mohamed</creator><creator>Hasan, Afaf A.</creator><creator>Ahmed, Mohamed A.</creator><creator>Seif, Hany M. A.</creator><creator>Yousif, Hazem A.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><general>SpringerOpen</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>DOA</scope></search><sort><creationdate>20200421</creationdate><title>Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study</title><author>Abdel-Tawab, Mohamed ; Hasan, Afaf A. ; Ahmed, Mohamed A. ; Seif, Hany M. A. ; Yousif, Hazem A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c496t-984ecba2c2eaa3f63f361d99a7b5d0fb33385b1514b769eb88c64ba8ba013ce93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aneurysms</topic><topic>Care and treatment</topic><topic>Cerebral ischemia</topic><topic>Clinical deterioration</topic><topic>Cohort analysis</topic><topic>Consciousness</topic><topic>Contrast agents</topic><topic>CT imaging</topic><topic>CT perfusion</topic><topic>Delayed cerebral ischemia</topic><topic>Diabetes</topic><topic>Fisher scale</topic><topic>Gender</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Hunt and Hess scale</topic><topic>Hypertension</topic><topic>Imaging</topic><topic>Ischemia</topic><topic>Medical prognosis</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Nuclear Medicine</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Radiology</topic><topic>Software</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Stroke (Disease)</topic><topic>Subarachnoid hemorrhage</topic><topic>Vasospasm</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abdel-Tawab, Mohamed</creatorcontrib><creatorcontrib>Hasan, Afaf A.</creatorcontrib><creatorcontrib>Ahmed, Mohamed A.</creatorcontrib><creatorcontrib>Seif, Hany M. A.</creatorcontrib><creatorcontrib>Yousif, Hazem A.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Egyptian Journal of Radiology and Nuclear Medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdel-Tawab, Mohamed</au><au>Hasan, Afaf A.</au><au>Ahmed, Mohamed A.</au><au>Seif, Hany M. A.</au><au>Yousif, Hazem A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study</atitle><jtitle>Egyptian Journal of Radiology and Nuclear Medicine</jtitle><stitle>Egypt J Radiol Nucl Med</stitle><date>2020-04-21</date><risdate>2020</risdate><volume>51</volume><issue>1</issue><spage>61</spage><epage>10</epage><pages>61-10</pages><artnum>61</artnum><issn>2090-4762</issn><issn>0378-603X</issn><eissn>2090-4762</eissn><abstract>Background
Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds.
This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction.
Results
Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s.
Conclusion
MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1186/s43055-020-00180-8</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Springer Nature OA Free Journals |
| subjects | Aneurysms Care and treatment Cerebral ischemia Clinical deterioration Cohort analysis Consciousness Contrast agents CT imaging CT perfusion Delayed cerebral ischemia Diabetes Fisher scale Gender Hematoma Hemorrhage Hunt and Hess scale Hypertension Imaging Ischemia Medical prognosis Medical research Medicine Medicine & Public Health Medicine, Experimental Nuclear Medicine Patients Prognosis Radiology Software Statistical analysis Stroke Stroke (Disease) Subarachnoid hemorrhage Vasospasm |
| title | Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study |
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