The value of ASL combined with GCS score in predicting cognitive dysfunction in patients with aneurysmal subarach-noid hemorrhage

WANG Jingjing; ZHAO Xinbin; GUO Xiaoyan; ZHANG Limin

doi:10.20258/j.cnki.1006-9011.2025.01.001

Abstract：Objective The study aimed to investigate the value of arterial spin labeling(ASL)combined with the Glasgow Coma Scale(GCS)score in predicting cognitive dysfunction in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 105 aSAH patients admitted to our hospital were selected and classified into the dysfunction and normal groups based on their Montreal Cognitive Assessment Scale scores six months after discharge.Various parameters including age,Hunt-Hess Scale score,modified Fisher Scale score,GCS score,and ASL parameters were compared between the dysfunction and normal groups.Additionally,logistic regression was utilized to examine the potential risk factors associated with cognitive dysfunction in aSAH patients.The discriminatory power of each risk factor in defining cognitive dysfunction was assessed through receiver operating characteristic(ROC)curves,mean absolute error(MAE),mean square error(MSE),and decision analysis curve.Results Fifty-four cases(51.43%)displayed cognitive dysfunction six months after discharge.Notably,the dysfunction group exhibited higher age,Hunt-Hess Scale score,and modified Fisher Scale score,while displaying lower GCS score,ipsilat-eral regional cerebral blood flow(rCBF)value,and rCBF ratio as compared to the normal group(P<0.05).Logistic regression(Forward LR)analysis identified high GCS score and high rCBF ratio as independent protective factors against cognitive dysfunc-tion in aSAH patients after adjusting for age,Hunt-Hess Scale scores,modified Fisher Scale scores,ipsilateral rCBF values,and contralateral rCBF values(P<0.05).Furthermore,the combination of rCBF ratio and GCS score yielded a higher area under the ROC curve compared to rCBF ratio and GCS score alone,with lower MAE and MSE values.Additionally,the net benefit of rCBF ratio+GCS score in identifying cognitive dysfunction in aSAH patients surpassed that of rCBF ratio and GCS score across the majority of the threshold range.Conclusion A high rCBF ratio and a high GCS score suggest a reduced risk of cognitive dysfunction in aSAH patients 6 months after discharge.Furthermore,the combination of rCBF ratio and GCS score offers valu-able insights for assessing cognitive dysfunction in aSAH patients.