Permeability imaging as a predictor of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

Jonathan J Russin, Axel Montagne, Francesco D'Amore, Shuhan He, Mark S Shiroishi, Robert C Rennert, Jena Depetris, Berislav V Zlokovic, William J Mack

Research output: Contribution to journalArticlepeer-review


Blood-brain barrier (BBB) dysfunction has been implicated in ischemic risk following aneurysmal subarachnoid hemorrhage (aSAH), but never directly imaged. We prospectively examined whether post-bleed day 4 dynamic contrast-enhanced magnetic resonance (DCE-MR) BBB permeability imaging could predict development of delayed cerebral ischemia (DCI). Global MR-derived BBB permeability ( Ktrans) was significantly higher in aSAH patients who subsequently developed DCI (five patients; 2.28 ± 0.09 × 10-3 min-1) compared to those who experienced radiographic vasospasm only (three patients; 1.85 ± 0.12 × 10-3 min-1; p < 0.05), or no vasospasm/ischemia (eight patients; 1.74 ± 0.07 × 10-3 min-1; p < 0.01). Ktrans > 2 × 10-3 min-1 predicted development of DCI (AUC = 0.98, 95% CI: 0.93-1). Global BBB dysfunction following aSAH is detectable with DCE-MR and predictive of ischemic risk.

Original languageEnglish
Pages (from-to)973-979
Number of pages7
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number6
Publication statusPublished - Jun 2018


  • Adult
  • Aged
  • Aged, 80 and over
  • Blood-Brain Barrier/diagnostic imaging
  • Brain Ischemia/diagnostic imaging
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Permeability
  • Predictive Value of Tests
  • Subarachnoid Hemorrhage/diagnostic imaging
  • Vasospasm, Intracranial/diagnostic imaging


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