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. 2018 Jun;39(6):1059-1064.
doi: 10.3174/ajnr.A5626. Epub 2018 Apr 12.

Association of Quantified Location-Specific Blood Volumes with Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

W E van der Steen  1   2   3   4 , I A Zijlstra  2 , D Verbaan  3 , A M M Boers  5   2   6 , C S Gathier  7 , R van den Berg  2 , G J E Rinkel  7 , B A Coert  3 , Y B W E M Roos  4 , C B L M Majoie  2 , H A Marquering  5   2
Affiliations

Association of Quantified Location-Specific Blood Volumes with Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

W E van der Steen et al. AJNR Am J Neuroradiol. 2018 Jun.

Abstract

Background and purpose: Delayed cerebral ischemia is a severe complication of aneurysmal SAH and is associated with a high case morbidity and fatality. The total blood volume and the presence of intraventricular blood on CT after aneurysmal SAH are associated with delayed cerebral ischemia. Whether quantified location-specific (cisternal, intraventricular, parenchymal, and subdural) blood volumes are associated with delayed cerebral ischemia has been infrequently researched. This study aimed to associate quantified location-specific blood volumes with delayed cerebral ischemia.

Materials and methods: Clinical and radiologic data were collected retrospectively from consecutive patients with aneurysmal SAH with available CT scans within 24 hours after ictus admitted to 2 academic centers between January 2009 and December 2011. Total blood volume was quantified using an automatic hemorrhage-segmentation algorithm. Segmented blood was manually classified as cisternal, intraventricular, intraparenchymal, or subdural. Adjusted ORs with 95% confidence intervals for delayed cerebral ischemia per milliliter of location-specific blood were calculated using multivariable logistic regression analysis.

Results: We included 282 patients. Per milliliter increase in blood volume, the adjusted OR for delayed cerebral ischemia was 1.02 (95% CI, 1.01-1.04) for cisternal, 1.02 (95% CI, 1.00-1.04) for intraventricular, 0.99 (95% CI, 0.97-1.02) for intraparenchymal, and 0.96 (95% CI, 0.86-1.07) for subdural blood.

Conclusions: Our findings suggest that in patients with aneurysmal subarachnoid hemorrhage, the cisternal blood volume has a stronger relation with delayed cerebral ischemia than the blood volumes at other locations in the brain.

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Figures

Fig 1.
Fig 1.
Classification of the total blood volume as cisternal, intraventricular, intraparenchymal, and subdural. 1A, Axial slice of a noncontrast CT of a patient with aSAH with concomitant IVH and IPH. 1B, Quantified total blood volume. 1C, Classified cisternal (red), intraventricular (magenta), and intraparenchymal (green) blood. 2A, Axial slice of a noncontrast CT scan of a patient with aSAH with concomitant IVH and SDH. 2B. Quantified total blood volume. 2C, Classified cisternal (red), intraventricular (magenta), and subdural (blue) blood.
Fig 2.
Fig 2.
Dot boxplot of quantified cisternal blood volume in patients with and without DCI.
See this image and copyright information in PMC

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