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. 2024 Sep 2:15910199241277953.
doi: 10.1177/15910199241277953. Online ahead of print.

Perfusion imaging for delayed cerebral ischemia detection in patients following ruptured aneurysmal subarachnoid hemorrhage: Interrater reliability assessment

Anna Maria Bombardieri  1 , Anke Wouters  2 , Pierre Seners  3 , Aroosa Zamarud  4 , Michael Mlynash  5 , Nicole Yuen  5 , Greg W Albers  5 , Eric S Sussman  6 , Benjamin Pulli  4 , Maarten G Lansberg  5 , Gary K Steinberg  7 , Jeremy J Heit  4
Affiliations

Perfusion imaging for delayed cerebral ischemia detection in patients following ruptured aneurysmal subarachnoid hemorrhage: Interrater reliability assessment

Anna Maria Bombardieri et al. Interv Neuroradiol. .

Abstract

Background: Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is associated with adverse neurological outcomes. Early and accurate diagnosis of DCI is crucial to prevent cerebral infarction. This study aimed to assess the diagnostic accuracy and interrater agreement of the visual assessment of neuroimaging perfusion maps to detect DCI in patients suspected of vasospasm after aSAH.

Methods: In this case-control study, cases were adult aSAH patients with DCI who underwent magnetic resonance perfusion or computed tomography perfusion (CTP) imaging in the 24 h prior to digital subtraction angiography for vasospasm diagnosis. Controls were patients with dizziness and no aSAH on CTP imaging. Three independent raters, blinded to patients' clinical information, other neuroimaging studies, and angiographic results, visually assessed anonymized perfusion color maps to classify patients as either having DCI or not. Tmax delay was classified by symmetry into no delay, unilateral, or bilateral.

Results: Perfusion imaging of 54 patients with aSAH and 119 control patients without aSAH was assessed. Sensitivities for DCI diagnosis ranged from 0.65 to 0.78, and specificities ranged from 0.70 to 0.87, with interrater agreement ranging from 0.60 (moderate) to 0.68 (substantial).

Conclusion: Visual assessment of perfusion color maps demonstrated moderate to substantial accuracy in diagnosing DCI in aSAH patients.

Keywords: Delayed cerebral ischemia; aneurysmal subarachnoid hemorrhage; computed tomography perfusion; magnetic resonance perfusion; vasospasm.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Heit is a consultant for Medtronic, MicroVention, iSchemaView and a member of advisory boards for iSchemaView, Balt, and MicroVention.Dr Albers reports equity and consulting for iSchemaView and consulting from Medtronic and Genetech.Dr Steinberg is consultant for Sanbio, Zeiss and Surgical Theatre, patents with Peter Lazic, US.Dr Sussman is a consultant for Cerenovus and Balt.

Figures

Figure 1.
Figure 1.
Delayed cerebral ischemia detection algorithm on perfusion maps. rCBV: regional cerebral blood volume; rCBF: regional cerebral blood flow; MTT: mean transit time; Tmax: time to maximum.
Figure 2.
Figure 2.
Enrollment flow diagram.
See this image and copyright information in PMC

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