Original Article
Journal of Cerebral Blood Flow & Metabolism (2003) 23, 1371–1377; doi:10.1097/01.WCB.0000090861.67713.10
Responses of Posttraumatic Pericontusional Cerebral Blood Flow and Blood Volume to an Increase in Cerebral Perfusion Pressure
Supported by the UK Government Technology Foresight Initiative and the Medical Research Council (Grant No G9439390 ID 65883). L. Steiner was supported by a Myron B. Laver Grant (Department of Anesthesia, University of Basel, Switzerland), a grant from the Margarete und Walter Lichtenstein-Stiftung (Basel, Switzerland), by the Swiss National Science Foundation, and was recipient of an Overseas Research Student Award (Committee of Vice-Chancellors and Principals of the Universities of the United Kingdom). J. Coles was funded by a Wellcome Research Training Fellowship and by a Beverley and Raymond Sackler Studentship Award. A. Johnston was supported by a grant from Codman.
Luzius A Steiner*,†,‡, Jonathan P Coles*,†, Andrew J Johnston*,†, Marek Czosnyka‡, Tim D Fryer*, Peter Smielewski*, Doris A Chatfield*, Raymond Salvador*, Franklin I Aigbirhio*, John C Clark*, David K Menon*,† and John D Pickard*,‡
- *Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge, UK.
- †University Department of Anesthesia, Addenbrooke's Hospital, Cambridge, UK.
- ‡Academic Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Correspondence: Luzius A Steiner, Department of Anaesthesia, University of Basel, Kantonsspital, 4031 Basel, Switzerland. E-mail: lsteiner@uhbs.ch.
Received 30 May 2003; Accepted 24 July 2003.
Abstract
In and around traumatic contusions, cerebral blood flow (CBF) is often near or below the threshold for ischemia. Increasing cerebral perfusion pressure (CPP) in patients with head injuries may improve CBF in these regions. However, the pericontusional response to this intervention has not been studied. Using positron emission tomography (PET), we have quantified the response to an increase in CPP in and around contusions in 18 contusions in 18 patients. Regional CBF and cerebral blood volume (CBV) were measured with PET at CPPs of 70 and 90 mmHg using norepinephrine to control CPP. Based upon computed tomography, regions of interest (ROIs) were placed as two concentric ellipsoids, each of 1-cm width, around the core of the contusions. Measurements were compared with a control ROI in tissue with normal anatomic appearance. Baseline CBF and CBV increased significantly with increasing distance from the core of the lesion. The increase in CPP led to small increases in CBF in all ROIs except the core. The largest absolute CBF increase was found in the control ROI. Relative CBF increases did not differ between ROIs so that ischemic areas remained ischemic. Pericontusional oedema on computed tomography was associated with lower absolute values of CBF and CBV but did not differ from nonoedematous tissue in the relative response to CPP elevation.
Keywords:
Traumatic brain injury, Cerebral contusion, Cerebral blood flow, Cerebral blood volume, Cerebral perfusion pressure, Positron emission tomography
