CT 灌注和通透性成像在外伤性脑损伤中的预后价值。
Prognostic value of CT perfusion and permeability imaging in traumatic brain injury.
机构信息
From the Clinical Institute of Radiology (J.A., K.Š.P.), University Medical Centre Ljubljana; Department of Radiology (J.A., K.Š.P.), Faculty of Medicine, University of Ljubljana; Division of Neurology (F.F.B.), University Medical Centre Ljubljana; Institute of Pathophysiology (F.F.B.), Faculty of Medicine, University of Ljubljana; Clinical Department of Anaesthesiology and Intensive Therapy (P.G.), Centre for Intensive Therapy, University Medical Centre Ljubljana; Department of Anaesthesiology with Reanimatology (P.G.), Faculty of Medicine, University of Ljubljana and Institute for Biostatistics and Medical Informatics (N.K.), Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
出版信息
J Trauma Acute Care Surg. 2021 Mar 1;90(3):484-491. doi: 10.1097/TA.0000000000002964.
BACKGROUND
Currently established prognostic models in traumatic brain injury (TBI) include noncontrast computed tomography (CT) which is insensitive to early perfusion alterations associated with secondary brain injury. Perfusion CT (PCT) on the other hand offers insight into early perfusion abnormalities. We hypothesized that adding CT perfusion and permeability data to the established outcome predictors improves the performance of the prognostic model.
METHODS
A prospective cohort study of consecutive 50 adult patients with head injury and Glasgow Coma Scale score of 12 or less was performed at a single Level 1 Trauma Centre. Perfusion CT was added to routine control CT 12 hours to 24 hours after admission. Region of interest analysis was performed in six major vascular territories on perfusion and permeability parametric maps. Glasgow Outcome Scale (GOS) was used 6 months later to categorize patients' functional outcomes to favorable (GOS score > 3) or unfavorable (GOS score ≤ 3). We defined core prognostic model, consisting of age, motor Glasgow Coma Scale score, pupillary reactivity, and CT Rotterdam Score. Next, we added perfusion and permeability data as predictors and compared updated models to the core model using cross-validated areas under the receiver operator curves (cv-AUC).
RESULTS
Significant advantage over core model was shown by the model, containing both mean cerebral extravascular-extracellular volume per unit of tissue volume and cerebral blood volume of the least perfused arterial territory in addition to core predictors (cv-AUC, 0.75; 95% confidence interval, 0.51-0.84 vs. 0.6; 95% confidence interval, 0.37-0.74).
CONCLUSION
The development of cerebral ischemia and traumatic cerebral edema constitutes the secondary brain injury and represents the target for therapeutic interventions. Our results suggest that adding CT perfusion and permeability data to the established outcome predictors improves the performance of the prognostic model in the setting of moderate and severe TBI.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
目前外伤性脑损伤（TBI）的预后模型包括非对比 CT，它对继发性脑损伤相关的早期灌注改变不敏感。而 CT 灌注（PCT）可以提供早期灌注异常的信息。我们假设，将 CT 灌注和通透性数据添加到现有的预后预测因子中，可以提高预后模型的性能。
方法
这是一项在单一的 1 级创伤中心进行的连续 50 例成人颅脑损伤和格拉斯哥昏迷量表评分 12 分或更低的前瞻性队列研究。在入院后 12 至 24 小时内，将灌注 CT 添加到常规的对照 CT 中。在灌注和通透性参数图上，对六个主要血管区域进行了感兴趣区域分析。6 个月后，使用格拉斯哥结局量表（GOS）将患者的功能结局分为有利（GOS 评分＞3）或不利（GOS 评分≤3）。我们定义了核心预后模型，包括年龄、运动性格拉斯哥昏迷量表评分、瞳孔反应性和 CT 鹿特丹评分。接下来，我们添加了灌注和通透性数据作为预测因子，并使用交叉验证的接收者操作特征曲线下面积（cv-AUC）比较更新的模型与核心模型。
结果
与核心模型相比，包含组织容积中每个单位的平均脑血管外-细胞外容积和最灌注不良动脉区域的脑血容量的模型显示出显著的优势（cv-AUC，0.75；95%置信区间，0.51-0.84 与 0.6；95%置信区间，0.37-0.74）。
结论
脑缺血和外伤性脑水肿的发展构成了继发性脑损伤，是治疗干预的目标。我们的结果表明，在中重度 TBI 中，将 CT 灌注和通透性数据添加到现有的预后预测因子中，可以提高预后模型的性能。
证据水平
预后研究，III 级。
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