FUNCTIONAL NEURORADIOLOGY
Perfusion-CT for early assessment of traumatic
cerebral contusions
Jean F. Soustiel
&
Eugenia Mahamid
&
Dorith Goldsher
&
Menashe Zaaroor
Received: 6 June 2007 / Accepted: 26 October 2007 / Published online: 27 November 2007
#
Springer-Verlag 2007
Abstract
Introduction To investigate the value of perfusion-CT
(PCT) for assessment of traumatic cerebral contusions
(TCC) and to compare the abilities of early noncontrast
CT and PCT modalities to evaluate tissue viability.
Methods PCT studies performed in 30 patients suffering
from TCC during the acute phase of their illness were
retrospectively reviewed. Cerebral blood flow (CBF),
volume (CBV) and mean transit time (MTT) were
measured in three different areas: the hemorrhagic core of
the TCC, the surrounding hypodense area and the perile-
sional normal-appearing parenchyma. TCC area was mea-
sured on CBF-, CBV- and MTT-derived maps and
compared with the areas measured using the same slice
obtained with CT scans performed on admission, at the time
of PCT (follow-up CT) and at 1 week.
Results TCC were characterized by low CBF and CBV values
(9.2±6.6 ml/100 g per min and 0.9±0.7 ml/100 g, respectively)
and a significant prolongation of MTT (11.9±10.7 s) in the
hemorrhagic core whereas PCT parameters were more variable
in the hypodense area. The TCC whole area showed a
noticeable growth of the lesions during the first week of
admission. In comparison with early noncontrast CT, CBV and
CBF maps proved to be more congruent with the findings of
noncontrast CT scans at 1 week.
Conclusion PCT confirmed the results of xenon-CT studies
and was shown to allow better evaluation of tissue viability
than noncontrast CT. These findings suggest that PCT could
be implemented in the future for the early assessment of
patients with traumatic brain injury.
Keywords Perfusion-CT
.
Traumatic brain injury
.
Cerebral contusions
.
Cerebral blood flow
.
Cerebral blood volume
Introduction
Cerebral contusions are one of the most common traumatic
findings, being present in up to 31% of initial imaging
studies of patients with traumatic brain injury (TBI) [1, 2].
Structurally, cerebral contusions are characterized by an
area of hemorrhagic necrosis surrounded by perilesional
edema. One of the most distinctive features of cerebral
contusions is their capacity to enlarge and become
significant space-occupying intracranial lesions, leading to
increased intracranial pressure and neurological deteriora-
tion. Studies based on serial imaging have related this
deterioration to evolving edema in the area surrounding the
contusion and enlargement of the hemorrhagic component
of the lesions [3, 4]. Indeed, in 729 patients with TBI
surveyed by the European Brain Injury Consortium,
Compagnone et al. found that cerebral contusions alone
(44%) or in association with subdural hematoma (29%)
were the most frequent indication for delayed surgical
intervention [5]. In addition, ultrastructural studies have
provided evidence of a progressive increase in neuronal
damage leading to growing of the area of necrosis,
enhancing the role played by cerebral contusions as a
vector of secondary brain damage [6].
As such, cerebral contusions are a major therapeutic
challenge in that they include a potentially growing mass
mixed with presumably viable tissue, which may be of
critical functional importance whenever surgical removal of
the lesion is contemplated in neurologically eloquent areas.
This inhomogeneity is often reflected on the initial CT scan
Neuroradiology (2008) 50:189–196
DOI 10.1007/s00234-007-0337-7
O00337; No of Pages
J. F. Soustiel (*)
:
E. Mahamid
:
D. Goldsher
:
M. Zaaroor
Department of Neurosurgery, Rambam Medical Center,
Faculty of Medicine, Technion - Israel Institute of Technology,
P.O. Box 9602, Haifa 31096, Israel
e-mail: j_soustiel@rambam.health.gov.il