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International Journal of Computer Assisted Radiology and Surgery

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10-08-2018 | Original Article

Volumetric analysis of intracranial vessels: a novel tool for evaluation of cerebral vasospasm

Authors: Axel Neulen, Tobias Pantel, Anna Dieter, Michael Kosterhon, Manfred Berres, Serge C. Thal, Marc A. Brockmann, Sven R. Kantelhardt

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 1/2019

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Abstract

Purpose

Together with other diagnostic modalities, computed tomography angiography (CTA) is commonly used to indicate endovascular vasospasm treatment after subarachnoid hemorrhage (SAH), despite the fact that objective, user-independent parameters for evaluation of CTA are lacking. This exploratory study was designed to investigate whether quantification of vasospasm by automated volumetric analysis of the middle cerebral artery M1 segment from CTA data could be used as an objective parameter to indicate endovascular vasospasm treatment.

Methods

We retrospectively identified SAH patients who underwent transcranial Doppler sonography (TCD), CTA, and CT perfusion (CTP), with or without subsequent endovascular treatment. We determined vessel volume/vessel length of the M1 segments from CTA data and used receiver operating characteristic curve analysis to determine the optimal threshold of vessel volume to predict vasospasm requiring endovascular treatment. In addition, blinded investigators independently analyzed TCD, CTA, and CTP data.

Results

Of 45 CTA examinations with corresponding CTP and TCD examinations (24 SAH patients), nine indicated the need for endovascular vasospasm treatment during examination. In our patients, vessel volume < 5.8 µL/mm was moderately sensitive but fairly specific to detect vasospasm requiring endovascular treatment (sensitivity, 67%; specificity, 78%; negative predictive value (NPV), 89%; positive predictive value (PPV), 46%). For CTA, CTP, and TCD, we found NPVs of 96%, 92%, and 89%, PPVs of 40%, 35%, and 35%, sensitivities of 89%, 78%, and 67%, and specificities of 67%, 64%, and 69%, respectively.

Conclusion

Vessel volumes could provide a new objective parameter for the interpretation of CTA data and could thereby improve multimodal assessment of vasospasm in SAH patients.

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Title: Volumetric analysis of intracranial vessels: a novel tool for evaluation of cerebral vasospasm
Authors: Axel Neulen
Tobias Pantel
Anna Dieter
Michael Kosterhon
Manfred Berres
Serge C. Thal
Marc A. Brockmann
Sven R. Kantelhardt
Publication date: 10-08-2018
Publisher: Springer International Publishing
Published in: International Journal of Computer Assisted Radiology and Surgery / Issue 1/2019
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI: https://doi.org/10.1007/s11548-018-1844-1

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Abstract

Purpose

Methods

Results

Conclusion

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