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Vol. 26, No. 2, 2008
Issue release date: August 2008
Section title: Original Paper
Cerebrovasc Dis 2008;26:163–170
(DOI:10.1159/000139664)

Visual Grading System for Vasospasm Based on Perfusion CT Imaging: Comparisons with Conventional Angiography and Quantitative Perfusion CT

Wintermark M. · Dillon W.P. · Smith W.S. · Lau B.C. · Chaudhary S. · Liu S. · Yu M. · Fitch M. · Chien J.D. · Higashida R.T. · Ko N.U.
Departments of aRadiology and bNeurology, University of California, San Francisco, Calif., USA

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/29/2007
Accepted: 2/27/2008
Published online: 6/17/2008

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 6

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: The purpose of this study was to compare simple visual grading of perfusion CT (PCT) maps to a more quantitative, threshold-based interpretation of PCT parameters in the characterization of presence and severity of vasospasm. Methods: Thirty-three patients with acute subarachnoid hemorrhage were enrolled in a prospective study and underwent a total of 40 paired PCT and digital subtraction angiography (DSA) examinations. A neuroradiologist and a neurologist reviewed the PCT mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume maps independently; they evaluated five anatomical regions (frontal, temporal, parietal, occipital/thalami, and basal ganglia/insula) and graded them for abnormality (0 if normal, 1 if abnormal in <50% of the region, and 2 if abnormal in ≧50% of the region). A third neuroradiologist blinded to the PCT results reviewed the DSA examinations and assessed 19 segments for the presence or absence of vasospasm. Correlation between PCT and DSA scores was assessed, as well as the sensitivity and specificity of PCT compared to DSA used as a gold standard. Results: MTT (R2 = 0.939) and CBF (R2 = 0.907) scores correlated best with DSA scores (p < 0.001). MTT scoring had a sensitivity of 92% and a specificity of 86% compared to DSA; CBF scoring had a sensitivity of 75% and a specificity of 95%. The interobserver agreement between neuroradiologist and neurologist was found to have kappa = 0.789 for MTT and 0.658 for CBF. Conclusion: We propose a user-friendly visual grading system for PCT maps in patients with suspected vasospasm. This visual approach compares favorably to the results of DSA. Sensitive MTT maps should be used for screening, and specific CBF maps for confirmation of vasospasm.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 10/29/2007
Accepted: 2/27/2008
Published online: 6/17/2008

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 6

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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