• J. Neurol. Neurosurg. Psychiatr. · Aug 2011

    Perfusion-diffusion mismatch in MRI to indicate endovascular treatment of cerebral vasospasm after subarachnoid haemorrhage.

    • Hartmut Vatter, Erdem Güresir, Joachim Berkefeld, Jürgen Beck, Andreas Raabe, Richard du Mesnil de Rochemont, Volker Seifert, and Stefan Weidauer.
    • Department of Neurosurgery, Goethe-University, Schleusenweg, 2-16, Frankfurt/Main D-60528, Germany. h.vatter@em.uni-frankfurt.de
    • J. Neurol. Neurosurg. Psychiatr. 2011 Aug 1;82(8):876-83.

    IntroductionEndovascular treatments such as transluminal balloon angioplasty and intra-arterial nimodipine represent rescue therapy for cerebral vasospasm (CVS) after aneurysmal subarachnoid haemorrhage (SAH). Both indication and data regarding its efficacy in the prevention of cerebral infarct are, however, inconsistent. Therefore, an MR based perfusion weighted imaging/diffusion weighted imaging (PWI/DWI) mismatch was used to indicate this treatment and to characterise its effectiveness.MethodsMRI was performed for suspicion of CVS. For quantitative evaluation, the brain was partitioned into 19 arbitrary segments of comparable volume. Segments with PWI/DWI mismatch were defined as 'segment at risk (SR)'. In these cases, MRI was followed by angiography (digital subtraction angiography (DSA)) including endovascular treatment. 48 ± 12 h after treatment, a second MRI was performed and the treatment was repeated if new or remaining SR were observed. Efficacy was classified as the percentage of reduced diameter of the proximal cerebral arteries on DSA following the treatment: mild (≥33%), moderate (34-66%) or severe (≥67%).Results48 treatment cycles, each consisting of MRI, DSA and a second MRI, were performed in 25 patients. During these cycles, 95 SR were identified. The infarct rate was significantly higher in SR (37%) compared with segments without risk (4%). The infarct rate in SR was significantly reduced if mild proximal CVS could be achieved. In the case of persistent severe CVS, infarcts occurred in all SR.ConclusionThe present series suggests that PWI/DWI mismatch is predictive of the development of infarct in the case of CVS. The infarct rate could, however, be improved if proximal CVS was sufficiently reduced.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…