Ilse H van de Wijgert1, Jacobus F A Jansen2,3,4,5, Jeanette Tas1, Fred A Zeiler6,7, Paulien H M Voorter2, Vera H J van Hal2, Marcel J Aries8,9. 1. Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands. 2. Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. 3. Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands. 4. School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands. 5. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 6. Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 7. Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. 8. Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands. marcel.aries@mumc.nl. 9. School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands. marcel.aries@mumc.nl.
Abstract
INTRODUCTION: Traumatic brain injury (TBI) is associated with high mortality due to intracranial pressure (ICP). Whether computed tomography (CT) scanning of the brain within the first 24 h is indicative of intracranial hypertension is largely unknown. We assessed the feasibility of semi-automated CT segmentation in comparison with invasive ICP measurements. RELEVANCE: CT volumetry of the brain might provide ICP data when invasive monitoring is not possible or is undesirable. METHODS: We identified 33 patients with TBI who received a CT scan at admission and ICP monitoring within 24 h. Semi-automated segmentation of CT images in Matlab yielded cerebrospinal fluid (CSF) and intracranial volume (ICV) data. The ratio CSF/ICV × 100 (expressed as a percentage) was used as a proxy for ICP. The association between invasive ICP and the CSF/ICV ratio was evaluated using a simple linear regression model and a mono-exponential function derived from previous research in animals. RESULTS: ICP is moderately but significantly associated with the CSF/ICV ratio (r = -0.44, p = 0.01). The mono-exponential function provided a better fit of the relationship between ICP and the CSF/ICV ratio than the linear model. CONCLUSION: Our feasibility TBI data show that cross-sectional volumetric CT measures are associated with ICP. This non-invasive method can be used in future studies to monitor patients who are not candidates for invasive monitoring or to evaluate therapy effects objectively.
INTRODUCTION: Traumatic brain injury (TBI) is associated with high mortality due to intracranial pressure (ICP). Whether computed tomography (CT) scanning of the brain within the first 24 h is indicative of intracranial hypertension is largely unknown. We assessed the feasibility of semi-automated CT segmentation in comparison with invasive ICP measurements. RELEVANCE: CT volumetry of the brain might provide ICP data when invasive monitoring is not possible or is undesirable. METHODS: We identified 33 patients with TBI who received a CT scan at admission and ICP monitoring within 24 h. Semi-automated segmentation of CT images in Matlab yielded cerebrospinal fluid (CSF) and intracranial volume (ICV) data. The ratio CSF/ICV × 100 (expressed as a percentage) was used as a proxy for ICP. The association between invasive ICP and the CSF/ICV ratio was evaluated using a simple linear regression model and a mono-exponential function derived from previous research in animals. RESULTS: ICP is moderately but significantly associated with the CSF/ICV ratio (r = -0.44, p = 0.01). The mono-exponential function provided a better fit of the relationship between ICP and the CSF/ICV ratio than the linear model. CONCLUSION: Our feasibility TBI data show that cross-sectional volumetric CT measures are associated with ICP. This non-invasive method can be used in future studies to monitor patients who are not candidates for invasive monitoring or to evaluate therapy effects objectively.
Authors: Nancy Carney; Annette M Totten; Cindy O'Reilly; Jamie S Ullman; Gregory W J Hawryluk; Michael J Bell; Susan L Bratton; Randall Chesnut; Odette A Harris; Niranjan Kissoon; Andres M Rubiano; Lori Shutter; Robert C Tasker; Monica S Vavilala; Jack Wilberger; David W Wright; Jamshid Ghajar Journal: Neurosurgery Date: 2017-01-01 Impact factor: 4.654
Authors: Patrick Zuercher; Justus L Groen; Marcel J H Aries; Ewout W Steyerberg; Andrew I R Maas; Ari Ercole; David K Menon Journal: J Neurotrauma Date: 2016-02-11 Impact factor: 5.269