Steiner Luzius A, Coles Jonathan P, Johnston Andrew J, Czosnyka Marek, Fryer Tim D, Smielewski Peter, Chatfield Doris A, Salvador Raymond, Aigbirhio Franklin I, Clark John C, Menon David K, Pickard John D
Wolfson Brain Imaging Centre, University Department of Anesthesia, Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
J Cereb Blood Flow Metab. 2003 Nov;23(11):1371-7. doi: 10.1097/01.WCB.0000090861.67713.10.
In and around traumatic contusions, cerebral blood flow (CBF) is often near or below the threshold for ischemia. Increasing cerebral perfusion pressure (CPP) in patients with head injuries may improve CBF in these regions. However, the pericontusional response to this intervention has not been studied. Using positron emission tomography (PET), we have quantified the response to an increase in CPP in and around contusions in 18 contusions in 18 patients. Regional CBF and cerebral blood volume (CBV) were measured with PET at CPPs of 70 and 90 mmHg using norepinephrine to control CPP. Based upon computed tomography, regions of interest (ROIs) were placed as two concentric ellipsoids, each of 1-cm width, around the core of the contusions. Measurements were compared with a control ROI in tissue with normal anatomic appearance. Baseline CBF and CBV increased significantly with increasing distance from the core of the lesion. The increase in CPP led to small increases in CBF in all ROIs except the core. The largest absolute CBF increase was found in the control ROI. Relative CBF increases did not differ between ROIs so that ischemic areas remained ischemic. Pericontusional oedema on computed tomography was associated with lower absolute values of CBF and CBV but did not differ from nonoedematous tissue in the relative response to CPP elevation.
在创伤性挫伤及其周围，脑血流量（CBF）通常接近或低于缺血阈值。增加颅脑损伤患者的脑灌注压（CPP）可能会改善这些区域的CBF。然而，尚未研究挫伤周围组织对这种干预的反应。我们使用正电子发射断层扫描（PET）对18例患者的18处挫伤及其周围组织对CPP升高的反应进行了量化。使用去甲肾上腺素控制CPP，在70和90 mmHg的CPP水平下，通过PET测量局部CBF和脑血容量（CBV）。根据计算机断层扫描，将感兴趣区域（ROI）设置为围绕挫伤核心的两个同心椭圆体，每个宽度为1 cm。将测量结果与具有正常解剖外观的组织中的对照ROI进行比较。随着与病变核心距离的增加，基线CBF和CBV显著增加。CPP的增加导致除核心区域外的所有ROI的CBF略有增加。在对照ROI中发现绝对CBF增加最大。各ROI之间的相对CBF增加没有差异，因此缺血区域仍然缺血。计算机断层扫描上的挫伤周围水肿与较低的CBF和CBV绝对值相关，但在对CPP升高的相对反应中与非水肿组织没有差异。
