Blood-Brain Barrier Disruption Predicts Poor Outcome in Subarachnoid Hemorrhage: A Dynamic Contrast–Enhanced MRI Study

BACKGROUND: Spontaneous aneurysmal subarachnoid hemorrhage induces early blood-brain barrier permeability dysfunction, although its clinical relevance and underlying mechanisms remain poorly understood. We aimed to evaluate the association between blood-brain barrier disruption, quantified with dynamic contrast-enhanced magnetic resonance imaging at the end of the early brain injury period, circulating neuroinflammatory mediators, and long-term clinical outcomes. METHODS: We analyzed a prospective cohort of subarachnoid hemorrhage patients who underwent dynamic contrast-enhanced magnetic resonance imaging at a median (interquartile range) of 4 (2-6) days after clinical onset. Permeability maps were used to obtain K-trans values as a measure of increased blood-brain barrier permeability in the whole brain, gray matter, and white matter. Circulating neuroinflammatory molecules, including IL (interleukin) 8 and PDGF (platelet-derived growth factor), were measured using Multiplex-ELISA in blood samples collected concurrently with magnetic resonance imaging acquisition. Poor clinical outcome was defined as a modified Rankin Scale score of >2 at 90 days. Associations between K-trans values, neuroinflammatory mediators, and clinical outcomes were assessed using univariate and multivariate regression models. RESULTS: =0.003). CONCLUSIONS: Increased blood-brain barrier permeability correlates with circulating neuroinflammatory mediator levels and is associated with poor clinical recovery at 3 months. These findings support the potential role of white matter permeability alterations as both biomarker and therapeutic target in subarachnoid hemorrhage.