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Net Water Uptake and Cerebral Microcirculation in Perilesional Penumbra in TBI: CT Perfusion Study
Alex O Trofimov1, Ilya Kochsheev1, George Kalentyev1
1Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
Abstract:
The aim of our study was to compare brain tissue net water uptake (NWU), cerebral oxygenation, and microcirculation changes in perilesional penumbra foci (PPF) in moderate isolated traumatic brain injury (moiTBI) patients.
Materials And Methods:
77 moiTBI patients (women 35; men 42, age 37 years [34;39]) with unilateral frontal/frontotemporal lesions (Marshall II-III) were included in this retrospective, non-randomized, single-center study. Perfusion parameters were measured in PPF zones and determined using multiphase perfusion computed tomography (PCT) in the first 2 days after trauma and admission. NWU in hypoattenuated perilesional zones was calculated using non-contrast CT. Cerebral oxygenation (SctO2) was simultaneously measured using near-infrared spectroscopy in the frontal lobes with PCT. Data are shown as a median [interquartile range]. Statistical analysis was performed using nonparametric statistics. P < 0.05 was considered statistically significant.
Results:
In PPF, SctO2 was 64.03% [60.1;67.0], cerebral blood flow (CBF) was 30.6 ml/100 g/min [22.3; 38.7], cerebral blood volume (CBV) was 2 ml/100 g [1.6; 2.5], mean transit time (MTT) was 4.8 s [4.1;5.8], time to peak (TTP) was 21.8 s [20;24.2], NWU was 4.98% [2.21;7.39]. CBF, CBV, and SctO2 in PPF were significantly lower; MTT was more prolonged than in non-damaged tissue (p < 0.001). Increased NWU values in PPF were significantly correlated with CBV (r = 0.723, p < 0.001); CBF (r = -0.228, p = 0.048), TTP (r 0.225, p = 0.047), and SctO2 (r = -0.608, p < 0.001). There were no significant correlations between NWUPPF and MTT.
Conclusions:
Brain edema in PPF was significantly associated with cerebral microcirculation and cerebral O2 saturation disturbances in moiTBI.
Insights
Brain edema in moderate isolated traumatic brain injury (moiTBI) patients is linked to impaired cerebral microcirculation and oxygenation. Our findings highlight the association between net water uptake (NWU) and these critical changes in the perilesional penumbra foci (PPF).
Area of Science:
- Neuroscience
- Radiology
- Critical Care Medicine
Background:
- Moderate isolated traumatic brain injury (moiTBI) presents complex challenges in managing brain tissue viability.
- Understanding changes in the perilesional penumbra foci (PPF) is crucial for assessing injury severity and potential for recovery.
- Cerebral microcirculation and oxygenation are key indicators of brain tissue health following TBI.
Purpose of the Study:
- To compare brain tissue net water uptake (NWU), cerebral oxygenation, and microcirculation changes in the PPF of moiTBI patients.
- To investigate the relationship between NWU and cerebral perfusion parameters in the affected brain regions.
Main Methods:
- A retrospective study included 77 moiTBI patients with unilateral frontal/frontotemporal lesions (Marshall II-III).
- Multiphase perfusion computed tomography (PCT) was used to measure perfusion parameters in PPF within 2 days post-trauma.
- Non-contrast CT assessed NWU, while near-infrared spectroscopy measured cerebral oxygenation (SctO2) simultaneously with PCT.
Main Results:
- In PPF, cerebral blood flow (CBF), cerebral blood volume (CBV), and SctO2 were significantly lower, with a more prolonged mean transit time (MTT) compared to non-damaged tissue (p < 0.001).
- Increased NWU in PPF showed significant correlations with CBV (r=0.723, p<0.001), CBF (r=-0.228, p=0.048), time to peak (TTP) (r=0.225, p=0.047), and SctO2 (r=-0.608, p<0.001).
- No significant correlation was found between NWU and MTT.
Conclusions:
- Brain edema in the PPF of moiTBI patients is significantly associated with disturbances in cerebral microcirculation.
- Impaired cerebral oxygen saturation is also closely linked to brain edema development in the PPF following TBI.
- These findings underscore the importance of monitoring microcirculatory and oxygenation parameters in TBI management.
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