The role of early perfusion computed tomography in traumatic brain injury

UVOD Izid bolnikov po poškodbi glave (PG) je odvisen od primarnih in sekundarnih poškodb možganovine. Mehanizmi sekundarne poškodbe vključujejo spremembe na ravni možganske prekrvitve ter spremembe prepustnosti krvnomožganske pregrade (KMP). Uveljavljeni modeli za napovedovanje funkcijskega izida bolnikov s PG vključujejo nativno računalniško tomografijo (NCT), ki ima nizko občutljivost za zgodnjo zaznavo sekundarne poškodbe. Po drugi strani perfuzijska CT-preiskava (PCT) omogoča kvantitativno vrednotenje sprememb prekrvitve in prepustnosti KMP. Namen raziskave je bil preveriti, ali se kazalci prekrvitve in prepustnosti KMP razlikujejo med bolniki z ugodnim in neugodnim funkcijskim izidom ter ali ti podatki izboljšajo napovedno vrednost uveljavljenega prognostičnega modela. METODE Vključili smo 50 odraslih bolnikov s hudo in zmerno PG. Ob prvem kontrolnem NCT 12–24 ur po sprejemu smo opravili PCT-preiskavo ter v povirjih velikih možganskih arterij določili vrednosti kazalcev prekrvitve in prepustnosti KMP. Po 6 mesecih smo bolnike ocenili z uporabo Glasgowske lestvice izida (GOS) in razdelili bolnike na tiste z ugodnim (GOS>3) in neugodnim (GOS?3) izidom. Izhodiščnemu prognostičnemu modelu, ki je upošteval starost, motorično komponento GCS, zenične odzive in NCT, smo dodali kazalce možganske prekrvitve in prepustnosti KMP ter izdelane modele primerjali z izračunom prečno preverjenih ploščin (cv-AUC) pod krivuljami ROC. REZULTATI Kazalci možganske prekrvitve in prepustnosti KMP so se med skupinama značilno razlikovali. Model, ki je poleg izhodiščnih spremenljivk upošteval najnižjo izmerjeno vrednost možganskega volumna krvi (CBVmin) in povprečni volumski delež izvenžilnega izvenceličnega prostora (VEmean) je bil značilno boljši od izhodiščnega modela (cv-AUC [95-odstotni interval zaupanja] 0,75 [0,510,84] proti 0,6 [0,370,74]). ZAKLJUČKI Kazalci prekrvitve in prepustnosti KMP, pridobljeni s PCT-preiskavo, se med bolniki z ugodnim in neugodnim funkcijskim izidom po poškodbi glave razlikujejo. Podatki o prekrvitvi možganov in o prepustnosti KMP, ki jih pridobimo s PCT, lahko izboljšajo napovedno vrednost že uveljavljenih prognostičnih modelov pri bolnikih s hudo in zmerno PG.INTRODUCTION Outcome of traumatic brain injury (TBI) patients depends both on the primary and the secondary brain injury. Perfusion disturbances as well as blood-brain barrier permeability (BBBP) alterations constitute the pathophysiological mechanisms of secondary TBI. Currently established prognostic models in TBI include non-contrast computed tomography (NCCT) which is insensitive to early perfusion alterations associated with the secondary TBI. Perfusion CT (PCT) on the other hand offers insight into early perfusion abnormalities and allows the evaluation of BBBP as well. We hypothesized that PCT derived parameters of cerebral perfusion and BBBP differ between the outcome groups and that adding CT perfusion and permeability data to the established outcome predictors improves the performance of the prognostic model. METHODS A prospective cohort study of 50 adult patients with moderate and severe TBI was performed. PCT and routine control NCCT were performed 12-24 hours after admission and regions of interest were drawn on parametric maps in 6 major vascular territories. Glasgow Outcome Scale (GOS) was used 6 months later to categorize patients\u27 functional outcomes to favorable (GOS>3) or unfavorable (GOS⡤3). Core prognostic model consisted of age, motor GCS score (GCSm), pupillary reactivity and NCCT Score. We added perfusion and permeability data as predictors and compared updated models to the core model using cross-validated AUCs. RESULTS Perfusion and BBBP parameters differed significantly between the outcome groups. The prognostic model containing both minimal cerebral blood volume (CBVmin) and the average fraction of cerebral extravascular-extracellular volume (VEmean) in addition to age, GCSm, pupillary reaction, and NCCT score, performed better than the core model (cv-AUC (95% CI) 0.75 (0.51, 0.84) vs. 0.6 (0.37, 0.74)). CONCLUSIONS PCT derived perfusion and permeability parameters differed significantly between the outcome groups. Adding CT perfusion and permeability data to the established outcome predictors may improve the performance of the prognostic model

Retropharyngeal calcific tendinitis in the neurological emergency unit, report of three cases and review of the literature

Retropharyngeal calcific tendinitis (RCT) is a relatively benign condition of calcination of the longus colli muscle tendon of unknown origin, which causes severe acute neck pain. However, it is often not recognised, which leads to delayed diagnosis and unnecessary treatment

Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascular embolization followed by a Video-assisted thoracoscopic wedge resection. Keywords: Endovascular embolization, Intralobar pulmonary sequestratio

Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis

The aim of the study was to investigate the sensitivity and specificity of non-contrast computed tomography (NCCT) in the diagnosis of cerebral venous sinus thrombosis (CVST)

Blood-brain barrier permeability imaging using perfusion computed tomography

Background. The blood-brain barrier represents the selective diffusion barrier at the level of the cerebral microvascular endothelium. Other functions of blood-brain barrier include transport, signaling and osmoregulation. Endothelial cells interact with surrounding astrocytes, pericytes and neurons. These interactions are crucial to the development, structural integrity and function of the cerebral microvascular endothelium. Dysfunctional blood-brain barrier has been associated with pathologies such as acute stroke, tumors, inflammatory and neurodegenerative diseases

ADC values as a biomarker of fetal brain maturation

During the period of fetal development, myelination plays a key role and follows specific time and spatial sequences. The water content in the brain is inversely proportional to myelination – the more myelinated the brain, the lower the water content in it. The diffusion of water molecules can be quantitatively assessed using the apparent diffusion coefficient (ADC). We were interested in whether, by determining the ADC values, we could quantitatively evaluate the development of the fetal brain

Machine learning assisted DSC-MRI radiomics as a tool for glioma classification by grade and mutation status

Combining MRI techniques with machine learning methodology is rapidly gaining attention as a promising method for staging of brain gliomas. This study assesses the diagnostic value of such a framework applied to dynamic susceptibility contrast (DSC)-MRI in classifying treatment-na\uefve gliomas from a multi-center patients into WHO grades II-IV and across their isocitrate dehydrogenase (IDH) mutation status