[Investigation methods of cerebral perfusion].
Brain energy metabolism is essentially oxydative, through the glycolysis and the Krebs cycle. Brain tissue cannot survive more than a few minutes if the substrate (glucose, for which there is no endogenous reserve) or oxygen supply is abolished. Otherwise, there is a precise matching between perfusion (cerebral blood flow-CBF) and oxydative (oxygen consumption-CMRO2) and glycolytic regional metabolism. When intraarterial pressure is decreased (due to a systemic arterial pressure impairment or an arterial obstructive lesion), CBF is maintained constant through an increase of the pial vessels caliber and therefore an enhancement of the cerebral blood volume (CBV); this is cerebral circulatory autoregulation. In physiologic conditions, any increase of the local metabolic demand (during a motor, sensory, or cognitive activation) is supplied through a local enhancement of perfusion, and reversely. Therefore, the measurement of brain perfusion is useful not only to assess the consequences of cerebrovascular or some other diseases, but also to observe the functions involved in the normal working brain. This measurement is most frequently focused on CBF (flow) parameter, but in some clinical circumstances the access to CBV will be also of major importance for a correct understanding of the physiological or pathophysiological situation. We shall describe the different methods available both in clinical and experimental practice, and shall indicate for each one its characteristics, advantages and pitfalls.
Derlon
J M
JM
Service de Neurochirurgie, CHRU, Caen.
D001921:Brain / Q000378:metabolism*; D002560:Cerebrovascular Circulation; D006801:Humans; D007201:Indicator Dilution Techniques; D010100:Oxygen / Q000378:metabolism; D015899:Tomography, Emission-Computed, Single-Photon
D010100:Oxygen
Méthodes d'investigation de la perfusion cérébrale.