Non-invasive quantitative monitoring of cerebral blood flow in aneurysmal subarachnoid haemorrhage with 99mTc-ECD

The purpose of this prospective study was to detect symptomatic cerebral vasospasm in aneurysmal subarachnoid haemorrhage (SAH) by a non-invasive mean cerebral blood flow (mCBF) quantification using Tc-99m-ethyl cysteinate dimer. Measurement of mCBF without blood sampling and single photon emission tomography (SPECT) were performed at 1 and 7 days after surgery in 35 consecutive SAH patients, of whom 16 were examined at day 30 as well. A decrease in mCBF of more than 10% on day 7 versus day 1 was considered to indicate vasospasm. On visual interpretation of SPECT, a perfusion decrease which appeared newly on day 7 was considered to indicate vasospasm. In total, nine of 35 patients had cerebral vasospasm confirmed by computed tomography (CT) and/or angiography. The mCBF measurement showed a 77.8% (7/9) sensitivity, a 88.5% (23/26) specificity, a 70.0% (7/10) positive predictive value, and a 92.0% (23/25) negative predictive value. SPECT yielded a 33.3% (3/9) sensitivity, a 73.1% (19/26) specificity, a 30.0% (3/10) positive predictive value, and a 76.0% (19/25) negative predictive value. On SPECT, decreased perfusion was observed in most of the patients at clipping sites, which might represent post-operative transient abnormal perfusion and should not be read as vasospasm. In conclusion, thus mCBF measurement is more accurate than visual interpretation of SPECT for detecting vasospasm. ((C) 2002 Lippincott Williams & Wilkins).