Artikel
A CT-based classification of cerebral edema following acute cerebral lesions – correlation with intracranial pressure and outcome
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Autoren
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Stefanie Lietke
- Klinikum der Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Zausinger Stefan
- Klinikum der Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Brem Christian
- Klinikum der Universität München, Abteilung für Neuroradiologie, München, Deutschland
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Markus Holtmannspötter
- Klinikum der Universität München, Abteilung für Neuroradiologie, München, Deutschland
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Mathias Kunz
- Klinikum der Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Brain edema due to acute cerebral lesions may lead to raised intracranial pressure (ICP), impaired cerebral blood flow and mass effects. Nevertheless a CT-based scoring system of the extent of edema formation is still lacking. Aim of this retrospective correlative analysis was to establish a valid and definite CT score for a quantification of the extent of brain edema after common acute cerebral lesions.
Methods: 169 CT investigations in 60 patients were enrolled: - traumatic brain injury (TBI; n=47), subarachnoid hemorrhage (SAH; n=70), intracerebral hemorrhage (ICH; n=42) and ischemic stroke (n=10). The extent of edema formation was determined using a 5 point scale: 0 no edema, 1 focal ≤ 1 lobe, 2 unilateral > 1 lobe, 3 bilateral, 4 global with disappearance of gyral/sulcal relief, 5 global with additional basal cisterns effacement. The ICP was simultaneously measured at the site of the lesion and GOS were correlated.
Results: Patients’ mean age was 56.7 years. 81.7% of patients initially presented with a Glasgow coma scale (GCS) of 8 or less. ICP in local (grade 1-3) edema significantly differed from global (grade 4-5) edema (median 13mmHg vs 19.5mmHg, p<0.001). Median ICP values were 12mmHg [6-18] in grade 1, 13mmHg [8-20] in grade 2, 14mmHg [6-35] in grade 3 (grade 3 vs grade 1-2, p=0.07), 17mmHg [11-30] in grade 4 (grade 4 vs 3, p=0.002) and 21mmHg [15-85] in grade 5 (grade 5 vs 4, p=0.02). The radiologically determined extent of edema in 169 CT investigations significantly correlated with ICP (r=0.51; p<0.0001) in focal and global cerebral edema, particularly in patients with TBI, SAH and ICH (r=0.5, p<0.001; r=0.5; p<0.0001; r=0.6, p<0.0001, respectively). The CT-score of cerebral edema in all patients correlated with the outcome (r= -0.3, p=0.046; GOS 5/4 23%, GOS 3/2 65%, GOS 1 12%).
Conclusion: Grading of the extent of cerebral edema in CT significantly correlated with simultaneously measured ICP in TBI, SAH and ICH. The proposed CT-score may be helpful for standardized descriptions of CT-images and suitable as a parameter for clinical studies, e.g. measuring effects of antiedematous therapies.
