Admission perfusion CT: prognostic value in patients with severe head trauma.
OBJECTIVE
To assess the prognostic value of admission perfusion computed tomography (CT) in patients with severe head trauma.


METHODS
This prospective study included 130 patients with severe trauma, aged 19-86 years, admitted with a Glasgow Coma Scale score of 8 or less. They underwent perfusion CT as part of their admission CT survey. Clinical data, unenhanced cerebral CT findings, and perfusion CT scans were evaluated with respect to the Glasgow Outcome Scale (GOS) score at 3 months. Perfusion CT features were evaluated in patients with intracranial hypertension, cerebral contusions, and juxtadural hematomas. Ordered logistic regression was used to determine risk factors for an unfavorable GOS score at 3 months.


RESULTS
Perfusion CT was more sensitive than conventional unenhanced CT in the detection of cerebral contusions. Perfusion CT featured specific patterns with respect to patient outcome, with normal brain perfusion or hyperemia in patients with favorable outcome, and oligemia in patients with unfavorable outcome. The number of arterial territories with low regional cerebral blood volume at perfusion CT was an independent prognostic factor (P =.008), as were mean arterial pressure at the scene of accident (P =.083), base excess at admission (P =.002), presence of skull fractures (P =.041), and signs of herniation (P =.013) at admission unenhanced cerebral CT. Perfusion CT also showed a range of brain perfusion alterations in patients with juxtadural collections, cerebral edema, or intracranial hypertension.


CONCLUSIONS
Perfusion CT in patients with severe head trauma provides independent prognostic information regarding functional outcome.
Wintermark
Max
M
Department of Diagnostic and Interventional Radiology, Surgical Intensive Care Unit, University Hospital, 1011 Lausanne, Switzerland. max_wintermark@hotmail.com
van Melle
Guy
G
Schnyder
Pierre
P
Revelly
Jean-Pierre
JP
Porchet
François
F
Regli
Luca
L
Meuli
Reto
R
Maeder
Philippe
P
Chioléro
René
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D001921:Brain / Q000000981:diagnostic imaging*; D001929:Brain Edema / Q000209:etiology; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D003287:Contrast Media; D004636:Emergency Service, Hospital; D004677:Encephalocele / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D007472:Iohexol; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000150:complications; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D007472:Iohexol