HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wintermark, M. Articles by Chioléro, R. Search for Related Content PubMed PubMed Citation Articles by Wintermark, M. Articles by Chioléro, R.

Admission Perfusion CT: Prognostic Value in Patients with Severe Head Trauma¹

¹ From the Department of Diagnostic and Interventional Radiology (M.W., P.S., R.M., P.M.), Surgical Intensive Care Unit (J.P.R., R.C.), and Department of Neurosurgery (F.P., L.R.), University Hospital, 1011 Lausanne, Switzerland; and Biostatistics Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland (G.v.M.). Received May 27, 2003; revision requested August 6; final revision received December 3; accepted December 15. Address correspondence to M.W. (e-mail: max_wintermark@hotmail.com).

PURPOSE: To assess the prognostic value of admission perfusion computed tomography (CT) in patients with severe head trauma.

MATERIALS AND METHODS: This prospective study included 130 patients with severe trauma, aged 19–86 years, admitted with a Glasgow Coma Scale score of 8 or less. They underwent perfusion CT as part of their admission CT survey. Clinical data, unenhanced cerebral CT findings, and perfusion CT scans were evaluated with respect to the Glasgow Outcome Scale (GOS) score at 3 months. Perfusion CT features were evaluated in patients with intracranial hypertension, cerebral contusions, and juxtadural hematomas. Ordered logistic regression was used to determine risk factors for an unfavorable GOS score at 3 months.

RESULTS: Perfusion CT was more sensitive than conventional unenhanced CT in the detection of cerebral contusions. Perfusion CT featured specific patterns with respect to patient outcome, with normal brain perfusion or hyperemia in patients with favorable outcome, and oligemia in patients with unfavorable outcome. The number of arterial territories with low regional cerebral blood volume at perfusion CT was an independent prognostic factor (P = .008), as were mean arterial pressure at the scene of accident (P = .083), base excess at admission (P = .002), presence of skull fractures (P = .041), and signs of herniation (P = .013) at admission unenhanced cerebral CT. Perfusion CT also showed a range of brain perfusion alterations in patients with juxtadural collections, cerebral edema, or intracranial hypertension.

CONCLUSION: Perfusion CT in patients with severe head trauma provides independent prognostic information regarding functional outcome.

© RSNA, 2004

Index terms: Brain, CT, 10.12119 • Brain, edema, 10.436 • Brain, injuries, 10.436 • Computed tomography (CT), perfusion study, 10.12119

This article has been cited by other articles:

				M. Hauf, J. Slotboom, A. Nirkko, F. von Bredow, C. Ozdoba, and R. Wiest Cortical Regional Hyperperfusion in Nonconvulsive Status Epilepticus Measured by Dynamic Brain Perfusion CT AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 693 - 698. [Abstract] [Full Text] [PDF]

				G TAN and T GODDARD Neuroimaging applications of multislice CT perfusion Imaging, June 1, 2007; 19(2): 142 - 152. [Abstract] [Full Text] [PDF]

				M. Wintermark, M. Sesay, E. Barbier, K. Borbely, W. P. Dillon, J. D. Eastwood, T. C. Glenn, C. B. Grandin, S. Pedraza, J.-F. Soustiel, et al. Comparative Overview of Brain Perfusion Imaging Techniques Stroke, September 1, 2005; 36(9): e83 - e99. [Abstract] [Full Text] [PDF]