Bold MRI and vasospasm after aneurysmal subarachnoid hemorrhage: Developing a new approach  to an old problem

Leodante da Costa

Bold MRI and vasospasm after aneurysmal subarachnoid hemorrhage: Developing a new approach to an old problem

Leodante da Costa

University of Toronto, Canada

: J Diagn Tech Biomed Anal

Abstract

C urrently no biological or radiological marker is available to identify patients at risk of Delayed Is-Chemic Deficit (DIND) after Aneurysmal Sub-Arachnoid Hemorrhage (aSAH). We have described about our initial experience using MR-based semi- quantitative assessment of Cerebro-Vascular Reserve (CVR) to detect early radiological markers of vasospasm and DIND. Blood- Oxygen Level Dependent-MRI (BOLD-MRI) images with CO2 challenge was obtained in 5 patients with aSAH for assessment of whole brain CVR. Patients were examined as soon as possible after aneurysm treatment and good quality anatomical and functional images were obtained without complications. Initial anatomical cerebrovascular imaging showed no vasospasm in all patients. Two patients had abnormal CVR-MRI tests and both developed DIND. Of the 3 others with normal CVR-MRI, one developed posterior circulation DIND. One patient with a normal CVR-MRI developed angiographic vasospasm but no DIND. Changes in CVR maps as early as 36 hours after hemorrhage (day 1 of SAH) had good spatial correlation with delayed ischemia during short-term follow-up. Our series shows that MRI with CO2 challenge is feasible in this population, known to be difficult to study in the acute phase. Further developments might allow BOLD-MRI with CO2 challenge to identify patients at risk and provide anatomical correlation with future DIND, opening a new venue for prophylactic treatments.