Perfusion-CT for early assessment of traumatic cerebral contusions

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 perilesional normal-appearing parenchyma. TCC area was measured 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.