脑 CT 灌注在严重创伤性脑损伤中提供了额外的有用信息。

Brain CT perfusion provides additional useful information in severe traumatic brain injury.

机构信息

Department of Traumatology, Newcastle, NSW, Australia.

出版信息

Injury. 2013 Sep;44(9):1208-12. doi: 10.1016/j.injury.2013.03.039. Epub 2013 Apr 30.

DOI:10.1016/j.injury.2013.03.039

PMID:23642628

Abstract

BACKGROUND

The role of brain CT perfusion (CTP) imaging in severe traumatic brain injury (STBI) is unclear. We hypothesised that in STBI early CTP may provide additional information beyond the non contrast CT (NCCT).

METHODS

Subset analysis of an ongoing prospective observational study on trauma patients with STBI who did not require craniectomy and deteriorated or failed to improve neurologically during the first 48h from trauma. Subsequently to follow-up NCCT, a CTP was obtained. Additional findings were defined as an area of altered perfusion on CTP larger than the abnormal area detected by the simultaneous NCCT. Patients who had additional finding (A-CTP) were compared with patients who did not have additional findings (NA-CTP).

RESULTS

Study population was 30 patients [male: 90%, mean age: 38.6 (SD 16.9), blunt trauma: 100%; prehospital intubation: 6 (20%); lowest GCS before intubation: 5.1 (SD 2.0); mean ISS: 30.5 (SD 8.3); mean head and neck AIS: 4.4 (SD 0.8). Days in ICU: 10.2 (SD 6.3). Intracranial pressure (ICP) monitored in 12 (40%). Mean highest ICP in mmHg: 30.1 (SD14.1). There were five (17%) deaths. Findings of NCCT: primarily diffuse axonal injury (DAI) pattern in seven (23%), primarily haematoma in ten (33%), and primarily intracerebral contusion in nine (30%). CTP was performed 24.9 (SD 13) hours from trauma. There were 18 (60%) patients in the A-CTP group and 12 (40.0%) in NA-CTP. The A-CTP group was older (41.7 (SD16.9) vs 27.7 (SD 12.8): P<0.02) and showed on admission NCCT presence of cerebral contusion and absence of DAI. The degree of hypoperfusion was found to be severe enough to be in the ischaemic range in eight patients (27%). CTP altered clinical management in three patients (10%), who were diagnosed with massive and unsurvivable strokes despite minimal changes on NCCT.

CONCLUSION

When compared to NCCT, CTP provided additional diagnostic information in 60% of patients with STBI. CTP altered clinical management in 10% of patients.

摘要

背景

在严重创伤性脑损伤（STBI）中，脑 CT 灌注（CTP）成像的作用尚不清楚。我们假设，在 STBI 中，早期 CTP 可能提供比非对比 CT（NCCT）更多的信息。

方法

对未接受开颅术且在创伤后 48 小时内神经恶化或未能改善的 STBI 创伤患者进行的一项正在进行的前瞻性观察研究的亚组分析。随后在随访 NCCT 后进行 CTP 检查。附加发现定义为 CTP 上的灌注异常区域大于同时进行的 NCCT 检测到的异常区域。将有附加发现（A-CTP）的患者与没有附加发现（NA-CTP）的患者进行比较。

结果

研究人群为 30 名患者[男性：90%，平均年龄：38.6（SD 16.9），钝器伤：100%；院前插管：6（20%）；插管前最低 GCS：5.1（SD 2.0）；平均 ISS：30.5（SD 8.3）；平均头颈部 AIS：4.4（SD 0.8）。ICU 住院天数：10.2（SD 6.3）。12 例（40%）监测颅内压（ICP）。平均最高 ICP 为 30.1（SD14.1）mmHg。有 5 例（17%）死亡。NCCT 检查结果：7 例（23%）主要为弥漫性轴索损伤（DAI），10 例（33%）主要为血肿，9 例（30%）主要为脑挫裂伤。CTP 检查在创伤后 24.9（SD 13）小时进行。A-CTP 组 18 例（60%），NA-CTP 组 12 例（40.0%）。A-CTP 组年龄较大（41.7（SD16.9）比 27.7（SD 12.8）：P<0.02），入院时 NCCT 显示脑挫裂伤，无 DAI。8 例患者（27%）的灌注不足程度严重到处于缺血范围。CTP 在 3 例患者（10%）中改变了临床管理，尽管 NCCT 变化不大，但这些患者被诊断为大面积且无法存活的中风。