Jana Ivanidze1, Richard A Ferraro1, Ashley E Giambrone2, Alan Z Segal3, Ajay Gupta1, Pina C Sanelli1,4. 1. 1 Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 E 68th St, New York, NY 10065. 2. 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. 3. 3 Department of Neurology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. 4. 4 Department of Radiology, Northwell Health, Manhasset, NY.
Abstract
OBJECTIVE: The current understanding of the utility of blood-brain barrier permeability (BBBP) evaluation with extended-pass perfusion CT in the clinical setting is limited. We assessed whether BBBP parameters evaluated with perfusion CT correlate with unfavorable clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: A retrospective cross-sectional analysis was performed of 22 patients who underwent perfusion CT on days 0-3 after SAH. Extended perfusion CT data were postprocessed into BBBP quantitative maps of kep (washout rate constant of contrast agent from the extravascular extracellular space [EES] to the intravascular space), PS (permeability surface area product), Ktrans (volume transfer constant from blood plasma to EES), and Ve (EES volume per unit tissue volume) using Olea Sphere software (version 2.0). Clinical outcomes data regarding the presence of permanent neurologic deficits and modified Rankin scores were collected at discharge. ROC curve analyses and unpaired t tests were performed. RESULTS: The 22 patients were stratified on the basis of their clinical outcomes of permanent neurologic deficit and modified Rankin scores. In patients with unfavorable clinical outcomes (i.e., patients with permanent neurologic deficit and those with modified Rankin scores of 3-6), PS and Ve were significantly increased and kep and Ktrans were significantly decreased. A multiparameter ROC curve analysis combining the four parameters yielded an AUC of 0.80 for permanent neurologic deficit and an AUC of 0.89 for modified Rankin scores of 3-6. CONCLUSION: SAH patients with unfavorable outcomes had significantly elevated PS and Ve and significantly decreased kep, indicating increased BBBP, compared with SAH patients with unfavorable outcomes. Evaluation of BBBP parameters may provide prognostication of unfavorable outcomes in patients with SAH and help guide management.
OBJECTIVE: The current understanding of the utility of blood-brain barrier permeability (BBBP) evaluation with extended-pass perfusion CT in the clinical setting is limited. We assessed whether BBBP parameters evaluated with perfusion CT correlate with unfavorable clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: A retrospective cross-sectional analysis was performed of 22 patients who underwent perfusion CT on days 0-3 after SAH. Extended perfusion CT data were postprocessed into BBBP quantitative maps of kep (washout rate constant of contrast agent from the extravascular extracellular space [EES] to the intravascular space), PS (permeability surface area product), Ktrans (volume transfer constant from blood plasma to EES), and Ve (EES volume per unit tissue volume) using Olea Sphere software (version 2.0). Clinical outcomes data regarding the presence of permanent neurologic deficits and modified Rankin scores were collected at discharge. ROC curve analyses and unpaired t tests were performed. RESULTS: The 22 patients were stratified on the basis of their clinical outcomes of permanent neurologic deficit and modified Rankin scores. In patients with unfavorable clinical outcomes (i.e., patients with permanent neurologic deficit and those with modified Rankin scores of 3-6), PS and Ve were significantly increased and kep and Ktrans were significantly decreased. A multiparameter ROC curve analysis combining the four parameters yielded an AUC of 0.80 for permanent neurologic deficit and an AUC of 0.89 for modified Rankin scores of 3-6. CONCLUSION:SAHpatients with unfavorable outcomes had significantly elevated PS and Ve and significantly decreased kep, indicating increased BBBP, compared with SAHpatients with unfavorable outcomes. Evaluation of BBBP parameters may provide prognostication of unfavorable outcomes in patients with SAH and help guide management.
Authors: Neil A Nadkarni; Matthew B Maas; Ayush Batra; Minjee Kim; Edward M Manno; Farzaneh A Sorond; Shyam Prabhakaran; Andrew M Naidech; Eric M Liotta Journal: J Stroke Cerebrovasc Dis Date: 2020-01-11 Impact factor: 2.136
Authors: Huiying Gu; Paul R Territo; Scott A Persohn; Amanda A Bedwell; Kierra Eldridge; Rachael Speedy; Zhe Chen; Wei Zheng; Yansheng Du Journal: J Trace Elem Med Biol Date: 2020-09-19 Impact factor: 3.849