title: Brain CT perfusion provides additional useful information in severe traumatic brain injury.
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.
  
  
  CONCLUSIONS
  When compared to NCCT, CTP provided additional diagnostic information in 60% of patients with STBI. CTP altered clinical management in 10% of patients.
authors: Department of Traumatology, Newcastle, NSW, Australia. Cino.bendinelli@hnehealth.nsw.gov.au
authors: Cino
authors: C
authors: Bendinelli
authors: Andrew
authors: A
authors: Bivard
authors: Shane
authors: S
authors: Nebauer
authors: Mark W
authors: MW
authors: Parsons
authors: Zsolt J
authors: ZJ
authors: Balogh
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D055420:Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D020521:Stroke / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
keywords: Brain CT perfusion (CTP); Post-traumatic stroke; Severe traumatic brain injury (STBI)