The evaluation of the brain damage in patients with aneurysmal subarachnoid hemorrhage and the investigating of the predictability of the clinical worsening patients in follow-up period using arterial spin labelling perfusion imaging

Purpose: SAH is a neurological condition with an annual incidence of 6-22 per 100,000. Despite many advances in diagnosis, mortality and morbidity in patients remain high. One of the most important causes of mortality and morbidity is vasospasm and delayed ischemic neurologic deficit (Delayed ischemic neurologic deficit; DIND). The aim of this study was to demonstrate brain damage with ASL perfusion MR imaging and to evaluate the predictability of delayed ischemic neurologic deficit development. Materials and Methods: Following the preparation of our study's protocol, approval was obtained from the Clinical Research Ethics Committee of Karadeniz Technical University with the decision numbered 24237859-896 on 20.12.2019. After the approval, the prospectively collected data of 23 patients diagnosed with SAH in the relevant branches between 2020-2021 were analyzed retrospectively. Patients' demographics, aneurysm localization and dimensions, treatment method, treatment efficacy, complication rates, early and late ASL results were evaluated. Findings: The first 3 days ASL values obtained from 23 of the patients included in the study, bleeding in the right or left sulcal distances was asymmetrical in 21 patients (91.3%). ASL signal mean of all areas obtained in 18 (85.7%) of 21 patients with right or left asymmetric bleeding intensity was lower than the contralateral side, consistent with the side with bleeding intensity. When the average of all areas except the basal ganglia was taken, the mean of ASL signal was lower in 19 of 21 patients (90.4%) compared to the contralateral side, consistent with the side with bleeding intensity. The difference was more pronounced when basal ganglia were not included in the mean. Conclusion: In selected patient groups, ASL perfusion MRI can show global or regional perfusion decline and possible cerebral damage without exposure to contrast material and radiation. We are of the opinion that studies with greater number of cases are necessary for the predictability of DIND development in later periods. Keywords: subrachnoid hemorrhage, ASL perfusion, delayed ischemic neurologic deficit