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Utility of admission perfusion CT for the prediction of suboptimal outcome following uncomplicated minor traumatic brain injury

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Abstract

Purpose

To compare the perfusion parameters of patients with uncomplicated mild traumatic brain injury (mTBI) with healthy controls and to assess whether admission perfusion CT parameters can be used to predict outcome at 6 months post-injury in patients with uncomplicated mTBI.

Methods

Institute ethical committee approval was obtained for this prospective cohort study and informed written consent obtained from all subjects. Patients who sustained mTBI and had no abnormalities on non-contrast CT from June 2010 to January 2012 (20 months) and 10 healthy controls were included and underwent perfusion CT at admission. Outcome was determined at 6 months follow-up using the extended Glasgow Coma Outcome Scale score.

Results

Forty-nine patients were included, of which 16 (32.7%) had symptoms at 6 months post-injury (suboptimal outcome). The mean cerebral blood flow and volume were lower in both the gray and white matter of all three arterial territories in the study group than in the control group (p value < 0.05). In the study group, these values were lower in those with suboptimal outcome than in those with optimal outcome (no symptoms). Cerebral blood flow showed higher area under the curve for predicting the outcome.

Conclusion

Perfusion parameters are altered even in patients with uncomplicated mTBI. A single ROI (region of interest) evaluation of the gray matter in the posterior cerebral artery territory on admission perfusion CT could provide a quick and efficient way to predict patients who would have a suboptimal outcome at 6 months post-injury.

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Abbreviations

AUC:

Area under the curve

CBF:

Cerebral blood flow

CBV:

Cerebral blood volume

GCS:

Glasgow Coma Scale

GOSE:

Extended Glasgow Outcome Scale

mTBI:

Mild traumatic brain injury

PCT:

Perfusion computed tomography

ROC:

Receiver operator characteristic

ROI:

Region of interest

TTP:

Time to peak

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Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Naren Hemachandran, Atin Kumar, Raju Sharma & Deepak Gupta

  2. Weston General Hospital (UHBW), Weston, UK

    Saroj Meena

  3. Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no. 81b, 110029, New Delhi, India

    Shivanand Gamanagatti

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  1. Naren Hemachandran
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  2. Saroj Meena
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  3. Atin Kumar
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  4. Raju Sharma
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Correspondence to Shivanand Gamanagatti.

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Hemachandran, N., Meena, S., Kumar, A. et al. Utility of admission perfusion CT for the prediction of suboptimal outcome following uncomplicated minor traumatic brain injury. Emerg Radiol 28, 541–548 (2021). https://doi.org/10.1007/s10140-020-01876-0

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  • DOI: https://doi.org/10.1007/s10140-020-01876-0

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