Relationship between brain perfusion computed tomography variables and cerebral perfusion pressure in severe head trauma patients*

Wintermark, Max; Chioléro, René; Melle, Guy van; Revelly, Jean Pierre; Porchet, François; Regli, Luca; Meuli, Reto; Schnyder, P.; Maeder, Philippe

doi:10.1097/01.ccm.0000130171.08842.72

Cited by 68 publications

(35 citation statements)

References 20 publications

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“…Focal perfusion abnormalities are typically observed in and around contusions, even before they become apparent on structural imaging (63)(64)(65). Perfusion, measured using Xenon-enhanced computed tomography (Xe-CT) (80)(81)(82)(83), CTP (63), and DSC-MRI (82)(83)(84), are altered in peri-contusional edematous regions, suggesting ongoing ischemic damage, and a role for perfusion imaging in prognosis (63,85). Focal brain perfusion abnormalities associated with extra-axial blood collections correlate with symptomatology.…”

Section: Conventional Mri Techniquesmentioning

confidence: 99%

Common data elements in radiologic imaging of traumatic brain injury

Haacke,

Duhaime,

Gean

et al. 2010

Magnetic Resonance Imaging

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164

166

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Traumatic brain injury (TBI) has a poorly understood pathology. Patients suffer from a variety of physical and cognitive effects that worsen as the type of trauma worsens. Some noninvasive insights into the pathophysiology of TBI are possible using magnetic resonance imaging (MRI), computed tomography (CT), and many other forms of imaging as well. A recent workshop was convened to evaluate the common data elements (CDEs) that cut across the imaging field and given the charge to review the contributions of the various imaging modalities to TBI and to prepare an overview of the various clinical manifestations of TBI and their interpretation. Technical details regarding state-of-the-art protocols for both MRI and CT are also presented with the hope of guiding current and future research efforts as to what is possible in the field. Stress was also placed on the potential to create a database of CDEs as a means to best record information from a given patient from the reading of the images.

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Section: Conventional Mri Techniquesmentioning

confidence: 99%

Common data elements in radiologic imaging of traumatic brain injury

Haacke,

Duhaime,

Gean

et al. 2010

Magnetic Resonance Imaging

Self Cite

164

166

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“…PCT results show specific patterns, linked to cerebral edema and intracranial hypertension [14,15]. Finally, the number of arterial territories with "low" rCBV values on PCT is an independent of the functional outcome, and this as early as on admission [11].…”

Section: Characterization Of Post Traumatic Cerebral Hemodynamicsmentioning

confidence: 92%

“…3). Furthermore, cerebral contusions are characterized by their specific capacity to enlarge and turn into large hemorrhagic lesions and have been shown to represent the most frequent indication for delayed surgical intervention [14]. Accord-ingly, cerebral contusions represent a common surgical dilemma by associating a potentially growing mass mixed with presumably viable tissue, a distinction of critical importance whenever surgery is considered, especially in neurologically eloquent areas.…”

Section: Assessment Of Intracranial Traumatic Lesionsmentioning

confidence: 99%

Perfusion-CT: A Non-Invasive Tool to Monitor Regional Brain Perfusion in Traumatic Brain Injury Patients and Therapies Impacting it

Wintermark

Soustie²

2010

TONEUROSJ

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There is a growing body of evidence suggesting imaging biomarkers to select patients with traumatic brain injury (TBI) for therapies, and to monitor the effects of these treatments. In this setting, advanced neuroimaging techniques such as perfusion-CT (PCT) can offer more clinically relevant pathophysiologic information than purely structural imaging such as conventional noncontrast CT. Patients with altered brain PCT results might be considered for more aggressive and early treatment to prevent intracranial hypertension, whereas patients with preserved brain perfusion might benefit from less invasive treatment. From a clinical trial perspective, better stratification of the patient population, and the use of advanced neuroimaging as a biomarker for response to intervention, could be expected to significantly reduce the number of patients required to assess a treatment effect and, therefore, expedite the clinical trial process. This article reviews the fundamental of perfusion-CT technique and its application to TBI.

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“…Later, these authors studied 61 patients with severe TBI using early PCT and recommended that intermittent PCT measurements, in addition to continuous CPP measurement, could be used to provide more information than the standard CPP protocol alone. 86 On the other hand, monitoring of brain tissue oxygen is an emerging tool and PCT assessment of a region of interest surrounding the monitor probe in the brain tissue showed a significant correlation between MTT and brain tissue oxygen. 23 Some also suggest that PCT performed before probe insertion can identify the high-risk region for tissue hypoxia, which the probe should target.…”

Section: Management Of Patients With Moderate or Severe Tbi: Cerebralmentioning

confidence: 99%

Clinical application of perfusion computed tomography in neurosurgery

Huang

Tsai

Kuo

et al. 2014

JNS

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Object Currently, perfusion CT (PCT) is a valuable imaging technique that has been successfully applied to the clinical management of patients with ischemic stroke and aneurysmal subarachnoid hemorrhage (SAH). However, recent literature and the authors' experience have shown that PCT has many more important clinical applications in a variety of neurosurgical conditions. Therefore, the authors share their experiences of its application in various diseases of the cerebrovascular, neurotraumatology, and neurooncology fields and review the pertinent literature regarding expanding PCT applications for neurosurgical conditions, including pitfalls and future developments. Methods A pertinent literature search was conducted of English-language articles describing original research, case series, and case reports from 1990 to 2011 involving PCT and with relevance and applicability to neurosurgical disorders. Results In the cerebrovascular field, PCT is already in use as a diagnostic tool for patients suspected of having an ischemic stroke. Perfusion CT can be used to identify and define the extent of the infarct core and ischemic penumbra core, and thus aid patient selection for acute reperfusion therapy. For patients with aneurysmal SAH, PCT provides assessment of early brain injury, cerebral ischemia, and infarction, in addition to vasospasm. It may also be used to aid case selection for aggressive treatment of patients with poor SAH grade. In terms of oncological applications, PCT can be used as an imaging biomarker to assess angiogenesis and response to antiangiogenetic treatments, differentiate between glioma grades, and distinguish recurrent tumor from radiation necrosis. In the setting of traumatic brain injury, PCT can detect and delineate contusions at an early stage. In patients with mild head injury, PCT results have been shown to correlate with the severity and duration of postconcussion syndrome. In patients with moderate or severe head injury, PCT results have been shown to correlate with patients' functional outcome. Conclusions Perfusion CT provides quantitative and qualitative data that can add diagnostic and prognostic value in a number of neurosurgical disorders, and also help with clinical decision making. With emerging new technical developments in PCT, such as characterization of blood-brain barrier permeability and whole-brain PCT, this technique is expected to provide more and more insight into the pathophysiology of many neurosurgical conditions.

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Relationship between brain perfusion computed tomography variables and cerebral perfusion pressure in severe head trauma patients*

Cited by 68 publications

References 20 publications

Common data elements in radiologic imaging of traumatic brain injury

Common data elements in radiologic imaging of traumatic brain injury

Perfusion-CT: A Non-Invasive Tool to Monitor Regional Brain Perfusion in Traumatic Brain Injury Patients and Therapies Impacting it

Clinical application of perfusion computed tomography in neurosurgery

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