Qualitative aspects of cranial CT perfusion scanning in a mixed neurosurgical patient collective.
BACKGROUND
In patients with ischemic stroke, computer tomography (CT) perfusion imaging provides rapid information on the penumbra adjacent to the infarct core. For neurosurgical patients with acute brain injury, the value of CT perfusion is undecided up to now. We present our experience in a series of 78 examinations in 35 patients with acute intracranial pathology.


METHODS
CT perfusion was performed with a Siemens Emotion Duo CT scanner using a single slice at the level of the upper basal ganglia. Color maps of time to peak (TTP), cerebral blood flow (CBF) and cerebral blood volume (CBV) were analyzed according to qualitative criteria. Quantitative evaluation with self-defined regions of interest was not performed due to repeatability problems and inconsistent data.


RESULTS
TTP showed an interhemispheric difference in 45% and regional prolongation in 16% of the scans. Global TTP was prolonged in 60%, while global CBF was reduced in 43%. Two patients showed hyperemia. A CBF/CBV mismatch, indicating non-infarcted penumbra at risk, was seen in 67%. Six patients with aneurysmal SAH showed reduced CBF, and consecutive angiography confirmed vasospasm in every case.


CONCLUSIONS
CT perfusion scanning gives valuable information at a low risk and with negligible additional time after a routine cranial CT. In our opinion, this modality may have considerable impact on the clinical management of severely brain injured patients in future.
Wolf
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S
Department of Neurosurgery, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Englschalkinger Strasse 77, 81925 München, Germany. Stefan.Wolf@operamail.com
Kuckertz
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N
Bauer
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Schürer
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Lumenta
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D001783:Blood Flow Velocity; D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001931:Brain Mapping; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D010477:Perfusion / Q000379:methods; D012039:Regional Blood Flow; D012886:Skull / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology