Cerebral vascular autoregulation assessed by perfusion-CT in severe head trauma patients.

Details

Serval ID
serval:BIB_06CFDA452210
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cerebral vascular autoregulation assessed by perfusion-CT in severe head trauma patients.
Journal
Journal of Neuroradiology. Journal de Neuroradiologie
Author(s)
Wintermark M., Chiolero R., Van Melle G., Revelly J.P., Porchet F., Regli L., Maeder P., Meuli R., Schnyder P.
ISSN
0150-9861 (Print)
ISSN-L
0150-9861
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
33
Number
1
Pages
27-37
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
PURPOSE: To use perfusion-CT technique in order to characterize cerebral vascular autoregulation in a population of severe head trauma patients with features of cerebral edema either on the admission or on the follow-up conventional noncontrast cerebral CT.
MATERIAL AND METHODS: A total of 80 perfusion-CT examinations were obtained in 42 severe head trauma patients with features of cerebral edema on conventional noncontrast cerebral CT, either on admission or during follow-up. Perfusion-CT results, i.e. the regional cerebral blood volume (rCBV) and flow (rCBF), were correlated with the mean arterial pressure (MAP) measured during each perfusion-CT examination. Ratios were defined to integrate the concept of cerebral vascular autoregulation, and cluster analysis performed, which allowed identification of different subgroups of patients. MAP values and perfusion-CT results in these groups were compared using Kruskal-Wallis and Wilcoxon (Mann-Whitney) tests. Moreover, the functional outcome of the 42 patients was evaluated 3 months after trauma on the basis of the Glasgow Outcome Scale (GOS) score and similarly compared between groups.
RESULTS: Three main groups of patients were identified: 1) 22 perfusion-CT examinations were collected in 13 patients, characterized by high rCBV and rCBF values and by significant dependence of perfusion-CT rCBV and rCBF results on MAP values (p<0.001), 2) 23 perfusion-CT examinations collected in 19 patients showing perfusion-CT results similar to control trauma subjects, and 3) 33 perfusion-CT collected in 16 patients, with low rCBV and rCBF values and near-independence of perfusion-CT results with respect to MAP values. The first group was interpreted as showing impaired cerebral vascular autoregulation, which was preserved in the third group. The second group was associated with the best functional outcome; it was linked to the first group, because eight patients went from one group to the other from admission to follow-up.
CONCLUSION: Perfusion-CT in severe head trauma patients was able to provide direct and quantitative assessment of cerebral vascular autoregulation with a single measurement. It could hence be used as a guide for brain edema therapy, as well as to monitor the treatment efficiency.
Keywords
Adult, Aged, Blood Pressure/physiology, Brain Edema/etiology, Brain Edema/physiopathology, Brain Injuries/complications, Brain Injuries/physiopathology, Cerebrovascular Circulation/physiology, Female, Follow-Up Studies, Homeostasis/physiology, Humans, Male, Middle Aged, Reproducibility of Results, Tomography, X-Ray Computed
Pubmed
Web of science
Create date
04/03/2008 14:58
Last modification date
20/08/2019 12:29
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