Philipp Gölitz1, Iris Kaschka2, Stefan Lang2, Karl Roessler3, Frauke Knossalla4, Arnd Doerfler2. 1. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. philipp.goelitz@uk-erlangen.de. 2. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. 3. Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany. 4. Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
Abstract
BACKGROUND: Our study aimed to evaluate whether the effect of an intra-arterial vasospasm therapy can be assessed quantitatively by in vivo blood flow analysis using the postprocessing algorithm parametric color coding (PCC). METHODS: We evaluated 17 patients presenting with acute clinical deterioration due to vasospasm following subarachnoidal hemorrhage treated with intra-arterial nimodipine application. Pre- and post-interventional DSA series were post-processed by PCC. The relative time to maximum opacification (rTmax) was calculated in 14 arterially and venously located points of interest. From that data, the pre- and post-interventional cerebral circulation time (CirT) was calculated. Additionally, the arterial vessel diameters were measured. Pre- and post-interventional values were compared and tested for significance, respectively. RESULTS: Flow analysis revealed in all arterial vessel segments a non-statistically significant prolongation of rTmax after treatment. The mean CirT was 5.62 s (±1.19 s) pre-interventionally and 5.16 s (±0.81 s) post-interventionally, and the difference turned out as statistically significant (p = 0.039). A significantly increased diameter was measurable in all arterial segments post-interventionally. CONCLUSION: PCC is a fast applicable imaging technique that allows via real-time and in vivo blood flow analysis a quantitative assessment of the effect of intra-arterial vasospasm therapy. Our results seem to validate in vivo that an intra-arterial nimodipine application induces not only vasodilatation of the larger vessels, but also improves the microcirculatory flow, leading to a shortened cerebral CirT that reaches normal range post-interventionally. Procedural monitoring via PCC offers the option to compare quantitatively different therapy regimes, which allows optimization of existing approaches and implementation of individualized treatment strategies.
BACKGROUND: Our study aimed to evaluate whether the effect of an intra-arterial vasospasm therapy can be assessed quantitatively by in vivo blood flow analysis using the postprocessing algorithm parametric color coding (PCC). METHODS: We evaluated 17 patients presenting with acute clinical deterioration due to vasospasm following subarachnoidal hemorrhage treated with intra-arterial nimodipine application. Pre- and post-interventional DSA series were post-processed by PCC. The relative time to maximum opacification (rTmax) was calculated in 14 arterially and venously located points of interest. From that data, the pre- and post-interventional cerebral circulation time (CirT) was calculated. Additionally, the arterial vessel diameters were measured. Pre- and post-interventional values were compared and tested for significance, respectively. RESULTS: Flow analysis revealed in all arterial vessel segments a non-statistically significant prolongation of rTmax after treatment. The mean CirT was 5.62 s (±1.19 s) pre-interventionally and 5.16 s (±0.81 s) post-interventionally, and the difference turned out as statistically significant (p = 0.039). A significantly increased diameter was measurable in all arterial segments post-interventionally. CONCLUSION: PCC is a fast applicable imaging technique that allows via real-time and in vivo blood flow analysis a quantitative assessment of the effect of intra-arterial vasospasm therapy. Our results seem to validate in vivo that an intra-arterial nimodipine application induces not only vasodilatation of the larger vessels, but also improves the microcirculatory flow, leading to a shortened cerebral CirT that reaches normal range post-interventionally. Procedural monitoring via PCC offers the option to compare quantitatively different therapy regimes, which allows optimization of existing approaches and implementation of individualized treatment strategies.
Authors: T Struffert; Y Deuerling-Zheng; T Engelhorn; S Kloska; P Gölitz; A Bozzato; M Kapsreiter; C M Strother; A Doerfler Journal: Clin Neuroradiol Date: 2013-03-23 Impact factor: 3.649
Authors: Vallabh Janardhan; Alessandra Biondi; Howard A Riina; Pina C Sanelli; Philip E Stieg; Y Pierre Gobin Journal: Neuroimaging Clin N Am Date: 2006-08 Impact factor: 2.264
Authors: P Gölitz; T Struffert; H Lücking; J Rösch; F Knossalla; O Ganslandt; Y Deuerling-Zheng; A Doerfler Journal: Clin Neuroradiol Date: 2012-12-14 Impact factor: 3.649
Authors: Lei Feng; Brian-Fred Fitzsimmons; William L Young; Mitchell F Berman; Erwin Lin; Beverly D L Aagaard; Hoang Duong; John Pile-Spellman Journal: AJNR Am J Neuroradiol Date: 2002-09 Impact factor: 3.825
Authors: Neeraj Badjatia; Mehmet A Topcuoglu; Johnny C Pryor; James D Rabinov; Christopher S Ogilvy; Bob S Carter; Guy A Rordorf Journal: AJNR Am J Neuroradiol Date: 2004-05 Impact factor: 3.825