• Irene van der Schaaf, Marieke J Wermer, Yolanda van der Graaf, Birgitta K Velthuis, Clemens I B van de Kraats, and Gabriel J E Rinkel.
• Department of Radiology, University Medical Centre, Utrecht, The Netherlands. i.vanderschaaf@rrr.azu.nl
• Stroke. 2006 Feb 1;37(2):409-13.

Background And PurposeDelayed cerebral ischemia (DCI) is an important cause of death and disability after subarachnoid hemorrhage. We studied the additional prognostic value of brain perfusion to 3 established predictors (age, clinical condition on admission, and amount of subarachnoid blood) for the development of DCI.MethodsWe included 69 patients scanned with perfusion--computed tomography within 72 hours after subarachnoid hemorrhage. For each patient, we determined cerebral blood flow (CBF) ratios of prespecified opposite regions of interest and the 3 established predictors. We calculated adjusted hazard ratios (HRs) for the CBF ratio and the 3 established predictors by means of multivariate analysis (Cox regression). The additional prognostic value of CBF ratios was assessed by comparing the area under the receiver operating characteristic curve (AUC) of 2 models: 1 with and 1 without addition of the CBF ratio to the 3 established predictors.ResultsThe CBF ratio was an independent predictor for the development of DCI (HR, 0.63; 95% CI, 0.46 to 0.86) as was clinical condition (HR, 1.47; 95% CI, 1.01 to 2.13). By adding the CBF ratio to the model with the 3 established predictors, the AUC of the receiver operating characteristic curve increased from 0.76 (95% CI, 0.65 to 0.89) to 0.81 (95% CI, 0.71 to 0.91). This trend toward an increased AUC suggests an improved predictive value.ConclusionsThe CBF ratio is an independent predictor for the development of DCI and can contribute to a better identification of patients at high risk for DCI.

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