Brain damage evaluation via arterial spin labeling perfusion imaging for patients with aneurysmal subarachnoid hemorrhage

Objective: Subarachnoid hemorrhage (SAH) is a neurological condition with an annual incidence of 6-22 per 100,000. Despite many advances in diagnosis, the rates of mortality and morbidity in patients remain high. The most important reason for this is complications accompanied by perfusion changes. The aim of our study was to show the perfusion changes with arterial spin labelling (ASL) after SAH. Materials and methods: In this prospective study, 23 patients diagnosed with aneurysmal SAH were evaluated by ASL perfusion imaging between days 1- 3 and 8-10. The mean signal intensities (SI) of both hemispheres from the anterior cerebral artery, middle cerebral artery, and basal ganglia were measured manually according to the region of interest. The relationship between the SI values calculated for both cerebral hemispheres, complications, and grading scales of the side with more intense (ipsilateral) and less (contralateral) bleeding were evaluated. Results: There was a significant difference in the ipsilateral/contralateral SI ratio (S-IIps/ConBGin) (p= 0.015) among all ASL values, including the basal ganglia between days 0-3 and 8-10. There was a significant negative correlation between ASL parameters and rating scale scores. Additionally, when the SIIps/ConBGinDay0-3 ratio cut-off value was <= 0.72, the sensitivity and specificity were 57.1% and 100.0%, respectively, in predicting non-fatal complications, and the sensitivity and specificity in predicting all complications, including death, were 55.6% and 100.0%, respectively. Conclusion: Global or regional perfusion decrease can be shown using ASL, with or without the development of vasospasm, without the need for exogenous contrast agent use.