Volumetric analysis of intracranial vessels: a novel tool for evaluation of cerebral vasospasm

  • Axel Neulen
  • Tobias Pantel
  • Anna Dieter
  • Michael Kosterhon
  • Manfred Berres
  • Serge C. Thal
  • Marc A. Brockmann
  • Sven R. KantelhardtEmail author
Original Article



Together with other diagnostic modalities, computed tomography angiography (CTA) is commonly used to indicate endovascular vasospasm treatment after subarachnoid hemorrhage (SAH), despite the fact that objective, user-independent parameters for evaluation of CTA are lacking. This exploratory study was designed to investigate whether quantification of vasospasm by automated volumetric analysis of the middle cerebral artery M1 segment from CTA data could be used as an objective parameter to indicate endovascular vasospasm treatment.


We retrospectively identified SAH patients who underwent transcranial Doppler sonography (TCD), CTA, and CT perfusion (CTP), with or without subsequent endovascular treatment. We determined vessel volume/vessel length of the M1 segments from CTA data and used receiver operating characteristic curve analysis to determine the optimal threshold of vessel volume to predict vasospasm requiring endovascular treatment. In addition, blinded investigators independently analyzed TCD, CTA, and CTP data.


Of 45 CTA examinations with corresponding CTP and TCD examinations (24 SAH patients), nine indicated the need for endovascular vasospasm treatment during examination. In our patients, vessel volume < 5.8 µL/mm was moderately sensitive but fairly specific to detect vasospasm requiring endovascular treatment (sensitivity, 67%; specificity, 78%; negative predictive value (NPV), 89%; positive predictive value (PPV), 46%). For CTA, CTP, and TCD, we found NPVs of 96%, 92%, and 89%, PPVs of 40%, 35%, and 35%, sensitivities of 89%, 78%, and 67%, and specificities of 67%, 64%, and 69%, respectively.


Vessel volumes could provide a new objective parameter for the interpretation of CTA data and could thereby improve multimodal assessment of vasospasm in SAH patients.


Delayed cerebral ischemia Posthemorrhagic cerebral vasospasm Subarachnoid hemorrhage Transcranial Doppler sonography Computed tomography angiography Computed tomography perfusion imaging 



Parts of this study are part of the doctoral thesis of T. Pantel, presented to the Medical Faculty of the Johannes Gutenberg University of Mainz. The study was supported by a grant of the Medical Center of the Johannes Gutenberg University Mainz (Stufe I Foerderung, grant to A.N.). The funder had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© CARS 2018

Authors and Affiliations

  • Axel Neulen
    • 1
  • Tobias Pantel
    • 1
  • Anna Dieter
    • 2
  • Michael Kosterhon
    • 1
  • Manfred Berres
    • 4
    • 5
  • Serge C. Thal
    • 3
  • Marc A. Brockmann
    • 2
  • Sven R. Kantelhardt
    • 1
    Email author
  1. 1.Department of NeurosurgeryUniversity Medical Center of MainzMainzGermany
  2. 2.Department of NeuroradiologyUniversity Medical Center of MainzMainzGermany
  3. 3.Department of AnesthesiologyUniversity Medical Center of MainzMainzGermany
  4. 4.Institute of Medical Biometry, Epidemiology and InformaticsUniversity Medical Center of MainzMainzGermany
  5. 5.Department of Mathematics and TechnologyUniversity of Applied Sciences KoblenzRemagenGermany

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