OJRad  Vol.1 No.2 , December 2011
Cerebral Blood Flow Measurement in the Assessment of Post-Traumatic Cerebral Contusions
ABSTRACT
Brain trauma (BT) is extremely common in the Western society, and has been identified as the main cause of death and disability in the under-40 age group. Many aspects of the pathophysiological mechanisms involved and the effect of changes in cerebral metabolism are unclear. The aim of this study was to establish the rela- tionship between anatomical changes and deranged cerebral perfusion in patients with cerebral contusions, using Computed Tomography (CT) and Single Proton Emission Computed Tomography (SPECT). Twenty- two (22) patients who had suffered BT were recruited. All patients underwent SPECT and CT head scans on the same day. 18 were men. Patient average age was 45.6. Patients were assessed using the Glasgow scale (average 10.6). Cause of trauma included traffic accidents (9 patients) and falls (13 patients). A 4-slice spiral CT scan was performed. For each contusion, areas of bleeding, edema, and healthy perilesional tissue were distinguished. SPECT was performed with 20 mCi of 99 mTcECD using a dual-head gamma camera (128 × 128 matrix). CT scan revealed a single lesion in 12 patients, and more than one lesion in 10. The biggest le- sions found on CT were located in the frontal region in 13 patients; temporal region in 4; and parietal region in 1; four patients had poorly defined lesions. A total absence of perfusion was visible in 18 patients in the hemorrhagic area and in 14 patients in the edema, In 7 cases SPECT showed hypoperfusion that did not cor- respond to any morphological changes on the CT scan. Quantitative of fused lesions appearing on both CT scan and SPECT revealed severe perfusion defects in the hemorrhagic area (17.8%) and in the edema (29.4%). In our study, regional cerebral blood flow add relevant information on encephalic damage in pa- tients with BT.

Cite this paper
nullPifarré, P. , Cuberas, G. , Benejam, B. , Frascherri, L. , Sahuquillo, J. and Castell-Conesa, J. (2011) Cerebral Blood Flow Measurement in the Assessment of Post-Traumatic Cerebral Contusions. Open Journal of Radiology, 1, 21-27. doi: 10.4236/ojrad.2011.12004.
References
[1]   J. Bruns Jr. and W. A. Hauser, “The Epidemiology of Traumatic Brain Injury: A Review,” Epilepsia, Vol. 44, Supplement 10, 2003, pp. 2-10. doi:10.1046/j.1528-1157.44.s10.3.x

[2]   F. Tagliaferri, C. Compagnone, M. Korsic, F. Servadei and J. Kraus, “A Systematic Review of Brain Injury Epidemiology in Europe,” Acta Neurochirurgica (Wien), Vol. 148, No. 3, 2006, pp. 255-268. doi:10.1007/s00701-005-0651-y

[3]   A. I. Maas, E. W. Steyerberg, G. D. Murray, R. Bullock, A. Baethmann, L. F. Marshall and G. M. Teasdale, “Why Have Recent Trials of Neuroprotective Agents in Head Injury Failed to Show Convincing Efficacy? A Pragmatic Analysis and Theoretical Considerations,” Neurosurgery, Vol. 44, No. 6, 1999, pp. 1286-1298. doi:10.1097/00006123-199906000-00076

[4]   R. M. Chesnut, “Secondary Brain Insults after Head Injury: Clinical Perspectives,” New horizons Baltimore Md, Vol. 3, No. 3, 1995, pp. 366-375.

[5]   G. J. Bouma and J. P. Muizelaar, “Evaluation of Regional Cerebral Blood Flow in Acute Head Injury by Stable Xenon-Enhanced Computerized Tomography,” ACTA Neu- rochirurgica Supplementum (Wien), Vol. 59, 1993, pp. 34-40.

[6]   J. P. Coles, P. S. Minhas, T. D. Fryer, P. Smielewski, F. Aigbirihio, T. Donovan, S. P. Downey, G. Williams, D. Chatfield, J. C. Matthews, A. K. Gupta, T. A. Carpenter, J. C. Clark, J. D. Pickard and D. K. Menon, “Effect of Hyperventilation on Cerebral Blood Flow in Traumatic Head Injury: Clinical Relevance and Monitoring Corre- lates,” Critical Care Medicine, Vol. 30, No. 9, 2002, pp. 1950-1959. doi:10.1097/00003246-200209000-00002

[7]   B. Jennett and M. Bond, “Assessment of Outcome after Severe Brain Damage: A Practical Scale,” Lancet, Vol 305, No. 7905, 1975, pp. 480-484. doi:10.1016/S0140-6736(75)92830-5

[8]   P. A. Jones, P. J. Andrews, S. Midgley, S. I. Anderson, I. R. Piper, J. L. Tocher, A. M. Housley, J. A. Corrie, J. Slattery and N. M. Dearden, “Measuring the Burden of Secondary Insults in Head-Injured Patients during Intensive care,” Journal of Neurosurgical Anesthesiology, Vol. 6, No. 1, 1994, pp. 4-14.

[9]   J. Sahuquillo, A. Rodríguez-Baeza, M. Vaguean, F. Reina, L. Campos and E. Rubio, “Autorregulación Cerebral: Con- ceptos Fisiopatológicos y Metodología para Su Valora- ción en el Paciente Neurotraumatizado,” Medicina Intensiva, Vol. 20, 1996, pp. 69-78.

[10]   G. J. Bouma, J. P. Muizelar and S. C. Choi, “Cerebral Cir- culation and Metabolism after Severe Traumatic Brain Injury: The Elusive Role of Ischaemia,” Journal of Neurosurgery, Vol. 75, No. 5, 1991, pp. 685-693. doi:10.3171/jns.1991.75.5.0685

[11]   J. Overgaard and W. A. Tweed, “Cerebral Circulation after Head Injury. Cerebral Blood Flow and Its Regulation after Closed Head Injury with Emphasis on Clinical Correlations,” Journal of Neurosurgery, Vol. 41, No. 5, 1974, pp. 531-541. doi:10.3171/jns.1974.41.5.0531

[12]   W. D. Obrist, T. W. Langfitt, J. L. Jaggi, J. Cruz and T. A. Gennarelli, “Cerebral Blood Flow and Metabolism in Comatose Patients with Acute Head Injury. Relationship to Intracranial Hypertension,” Journal of Neurosurgery, Vol. 61, No. 2, 1984, pp. 241-253. doi:10.3171/jns.1984.61.2.0241

[13]   G. J. Bouma, J. P. Muizelaar, W. A. Stringer, S. C. Choi, P. Fatouros and H. F. Young, “Ultra-Early Evaluation of Regional Cerebral Blood Flow in Severely Head-Injured Patients Using Xenon-Enhanced Computerized Tomography,” Journal of Neurosurgery, Vol. 77, No. 3, 1992, pp. 360-368. doi:10.3171/jns.1992.77.3.0360

[14]   J. P. Coles, P. S. Minhas, T. D. Fryer, P. Smielewski, F. Aigbirihio, T. Donovan, S. P. Downey, G. Williams, D. Chatfield, J. C. Matthews, A. K. Gupta, T. A. Carpenter, J. C. Clark, J. D. Pickard and D. K. Menon, “Effect of Hyperventilation on Cerebral Blood Flow in Traumatic Head Injury: Clinical Relevance and Monitoring Correlates,” Critical Care Medicine, Vol. 30, No. 9, 2002, pp. 1950-1959. doi:10.1097/00003246-200209000-00002

[15]   The Brain Trauma Foundation, “The American Association of Neurological Surgeons. The Joint Section on Neu- rotrauma and Critical Care. Methodology,” Journal of Neurotrauma, Vol. 17, No. 6-7, 2000, pp. 561-562.

[16]   H. M. Abdel-Dayem, H. Abu-Judeh, M. Kumar, et al., “SPECT Brain Perfusion Abnormalities in Mild or Moderate Traumatic Brain Injury,” Clinical Nuclear Medicine, Vol. 23, No. 5, 1998, pp. 309-317. doi:10.1097/00003072-199805000-00009

[17]   M. Furlan, G. Marchal, F. Viader, J. M. Derlon and J. C. Baron, “Spontaneous Neurological Recovery after Stroke and the Fate of the Ischemic Penumbra,” Annals of Neurology, Vol. 40, No. 2, 1996, pp. 216-226. doi:10.1002/ana.410400213

[18]   R. Invertí, G. Bellinzona and M. Langer, “Cerebral Tissue PO2 and SjvO2 Changes during Moderate Hyperventilation in Patients with Severe Traumatic Brain Injury,” Journal of Neurosurgery, Vol. 96, No. 1, 2002, pp. 97- 102. doi:10.3171/jns.2002.96.1.0097

[19]   G. Marchal, V. Beaudouin, P. Rioux, V. de la Sayette, F. Le Doze and F. Viader, “Prolonged Persistence of Substantial Volumes of Potentially Viable Brain Tissue after Stroke: A Correlative PET-TC Study with Voxel-Based Data Analysis,” Stroke, Vol. 27, No. 4, 1996, pp. 599-606. doi:10.1161/01.STR.27.4.599

[20]   W. D. Heiss, L. Kratch, A. Thiel, M. Grond and G. Pa- wlik, “Penumbral Probability Thresholds of Cortical Flu- mazenil Binding and Blood Flor Predicting Tissue Outcome in Patientes with Cerebral Ischaemia,” Brain, Vol. 124, No. 1, 2001, pp. 20-29. doi:10.1093/brain/124.1.20

[21]   H. M. Abdel-Dayem, H. Abu-Judeh, M. Kumar, et al., “SPECT Brain Perfusion Abnormalities in Mild or Moderate Traumatic Brain Injury,” Clinical Nuclear Medicine, Vol. 23, No. 5, 1998, pp. 309-317. doi:10.1097/00003072-199805000-00009

[22]   H. M. Abdel-Dayem, S. A. Sadek and K. Kouris, “Changes in Cerebral Perfusion after Acute Head Injury. Comparison of CT with 99mTc HMPAO SPECT,” Radiology, Vol. 165, 1987, pp. 221-226.

[23]   J. C. Masdeu, R. L. Van Heertum, A. Kleiman, et al., “Early SPECT in Mild Head Trauma. A Controlled Study,” Journal of Neuroimaging, Vol. 4, 1994, pp. 177-181.

[24]   B. G. Gray, M. Ichise, D. G. Chung, J. C. Kirsh and W. Franks, “Technetium-99m-HMPAO SPECT in the Eva- luation of Patients with a Remote History of Traumatic Brain Injury: A Comparison with X-Ray Computed Tomography,” Journal of Nuclear Medicine, Vol. 33, No. 1, 1992, pp. 52-58.

[25]   A. K. Mahapatra and R. Kamal, “A Textbook of Head Injury,” Modern Publishers, Delhi, 1999.

[26]   P. A. Hofman, S. Z. Stapert, M. J. Van Droonenbugh, et al., “MR Imaging, SPECT and Neurocognitive Peformance after Mild Traumatic Brain Injury,” American Jour- nal of Neuroradiology, Vol. 22, No. 3, 2001, pp. 441-449.

[27]   A. N. Lassen and J. Astrup, “Cerbral Blood Flor: Normal Regulation and Ischemic Thresholds,” In: P. R. Weinstein and A. I. Faden, Eds., Protection of the Brain from Ischemia, Williams and Wilkins, Baltimore, 1990, pp. 7-19.

[28]   N. K. Gowda, D. Agrawal, C. Bal, N. Chandrashekar, M. Tripati, G. P. Bandopadhyaya, A. Malhotra and A. K. Ma- hapatra, “Technetium Tc-99m Ethyl Cysteinate Dimer Brain Single-Photon Emission CT in Mild Traumatic Brain Injury: A Prospective Study,” American Journal of Neuroradiology, Vol. 27, No. 2, 2006, pp. 447-451.

[29]   M. Desco, J. López, C. Benito, A. Santos, P. Domínguez, S. Reig, C. Arango, P. García-Barreno, H. U. Lemke, M. W. Vannier, K. Inamura and A. G. Farman, “A Multimo- dality Workstation in Practice,” Computer Assisted Radiology and Surgery, 1999, pp. 218-222.

[30]   J. López, M. Desco, C. Benito, A. Santos and P. García- Barreno, “Estación de Tratamiento de Imagen Médica Mul- timodalidad,” Mapping, 1999.

 
 
Top