gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Perfusion-CT as a routine diagnostic tool in polytrauma patients with traumatic brain injury: a 9-month experience

Meeting Abstract

  • Mario Mühmer - Neurochirurgie, Sankt Gertruaden Krankenhaus, Berlin, Deutschland
  • Christopher Munoz-Bendix - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
  • Daniel Remmel - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
  • Robert Pannewitz - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Philipp Jörg Slotty - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.24.03

doi: 10.3205/17dgnc317, urn:nbn:de:0183-17dgnc3175

Published: June 9, 2017

© 2017 Mühmer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Secondary brain injury following severe traumatic brain injury (TBI) likely significantly contributes to overall TBI outcome. Perfusion deficits are thought to play an important role; these are at least partly triggered by local or global ICP increase. Perfusion-CT (PCT) is already established as an objective and sensitive examination tool to asses overall and local brain perfusion. We sought to determine the benefit of Perfusion-CT as an initial diagnostic tool after TBI in an emergency room setting suitable to support therapeutic decisions.

Methods: We introduced the use of Perfusion-CT as part of our standard diagnostic protocol after TBI. We prospectively analyzed every patient above 18 years of age in a 9-month period (January through September 2016) after TBI and a Glasgow Coma Scale (GCS) ≤ 8.The PCT was obtained right after the non-contrast CT scan of the head and before the following diagnostics of the cervical spine and whole body scan.

Results: From the 42 patients evaluated, 28 were male and 14 female. Mean age was 57.4 years. Median GCS was 3. A total of 17 patients (40.5%) had an acute subdural hematoma (aSDH), 10 (23.8%) had cerebral contusions, 1 (2.4%) had an epidural hematoma, 7 (16.7%) had a concussion, 4 (9.5%) had traumatic subarachnoid hemorrhage and 3 (7.1%) an intraparenchymal hemorrhage. None of the patients presented adverse events due to the contrast agent. Delays in therapeutic decision were not considered significant by the local joint trauma team. A significant increase in mean transit time (MTT) was observed comparing the injured hemisphere with less/non-injured hemisphere in the whole population investigated (40.8 ds vs. 36.2 ds, p=0.26). When comparing different pathologies this effect was only seen in aSDH (48.5 ds vs. 36.8 ds, p = 0.028). None of the other perfusion parameters did show significant differences.

Conclusion: Perfusion-CT as an initial diagnostic tool after TBI seems to be safe, efficient and feasible method to obtain additional information of brain tissue at risk in these patients. In aSDH a clear increase in MTT on the effected hemisphere is observed. The ongoing detailed analysis of the perfusion changes observed might improve pathophysiological understanding and decision making in trauma care.