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Reduced CBF recovery detected by longitudinal 3D‐ SSP SPECT analyses predicts outcome of postoperative patients after subarachnoid haemorrhage
Author(s) -
Mutoh Tatsushi,
Totsune Tomoko,
Takenaka Shunsuke,
Tatewaki Yasuko,
Nakagawa Manabu,
Suarez Jose I,
Taki Yasuyuki,
Ishikawa Tatsuya
Publication year - 2018
Publication title -
clinical and experimental pharmacology and physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 103
eISSN - 1440-1681
pISSN - 0305-1870
DOI - 10.1111/1440-1681.12867
Subject(s) - medicine , cerebral blood flow , confidence interval , subarachnoid hemorrhage , penumbra , nuclear medicine , single photon emission computed tomography , perfusion , odds ratio , subarachnoid haemorrhage , emission computed tomography , aneurysm , ischemia , cardiology , surgery
Summary The aim of this study was to evaluate the impact of cerebral blood flow ( CBF ) recovery obtained from brain single‐photon emission computed tomography ( SPECT ) images on postoperative outcome after aneurysmal subarachnoid haemorrhage ( SAH ). Twenty‐nine patients who had undergone surgical clipping for ruptured anterior communicating artery aneurysms were analyzed prospectively. Routine measurements of CBF were performed using technetium‐99 m hexamethyl propyleneamine oxine SPECT on days 4 and 14 after SAH . Regional voxel data analyzed by three dimensional stereotactic surface projection (3D‐ SSP ) were compared between patients and age‐matched normal database ( NDB ). In 3D‐ SSP analysis of all patients, cortical hypoperfusion around the surgical site in bilateral frontal lobes was evident on day 4 ( P < .05 vs NDB ), which was improved significantly on day 14. However, the recovery was less complete in patients with poor clinical grades ( P < .05) and presenting symptoms attributable to delayed cerebral ischaemia ( DCI ) ( P < .05) than those without. Multivariate analysis showed that patients with mild to moderate CBF recovery (relative Z‐score differences of <4) ( P = .014; odds ratio, 2.5; 95% confidence interval, 1.93–3.31) was independently associated with poor functional outcome at 3 months. We conclude that reduced CBF recovery detected by serial 3D‐ SSP SPECT image analyses can be a potential predictor of poor prognosis in postoperative patients after SAH .