1253. Use of MRI Vessel Wall Imaging to Predict Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Authors: Jacob Francis Baranoski, MD; Lea Alhilali, MD; Jason Divito, MD; Colin Przybylowski, MD; Timothy Ho, MD; Peter Nakaji, MD; Felipe Albuquerque, MD; Michael Lawton, MD; Andrew Ducruet, MD (Phoenix, AZ)

Introduction: Vasospasm is one of the most serious sequelae of aneurysmal subarachnoid hemorrhage (aSAH). Unfortunately, clinical findings and traditional imaging rating scores have poor predictive value for vasospasm. We sought to determine whether vessel wall enhancement (VWE) on black-blood vessel wall magnetic resonance (VW-MRI) can be used to effectively predict vasospasm in aSAH patients. Methods: A total of 48 vessels in 4 aSAH patients were evaluated at the time of presentation with high-resolution, black-blood fat suppressed pre- and post-contrast T1 weighted images (double inversion recovery turbo spin echo) on a 3T-scanner. Two fellowship-trained neuroradiologists blinded to all clinical data assessed each vertebral, basilar, superior cerebellar, posterior cerebral, middle cerebral, anterior cerebral, and internal carotid arteries for the presence of VWE. The same radiologists evaluated CTAs obtained on post-bleed day 7 for the presence of vasospasm. Results: VWE at the time of rupture was 85% sensitive and 67% specific for development of vasospasm on CTA seven days later, with a 76% PPV and 78% NPV. The OR for developing vasospasm in a given vessel if there was VWE of that vessel at the time of rupture was 2.5. The number of enhancing vessels in the anterior circulation appeared to correlate with a higher mRS, though this did not reach statistical significance (r=0.73, p=0.13). Presence of enhancement in either the internal carotid arteries or anterior cerebral arteries was significantly correlated with higher mRS at discharge (rpb=0.93, p=0.035). Conclusion: VWE on black-blood VW-MRI obtained upon initial presentation is a valuable tool to predict subsequent development of vasospasm in aSAH patients. This may allow earlier and more effective prophylactic treatment of vasospasm as well as help identify and streamline management of patients at low risk for vasospasm.