N (%)
GOS 1
Good recovery
GOS 2
Moderate disability
GOS 3
Severe disability
GOS 4
Vegetative state
GOS 5
Death
Total
Group 1
27
16
11
3
1
58 (100 %)
Group 2
25
14
8
8
3
58 (100 %)
Perfusion Computed Tomography
All patients were subjected to perfusion computed tomography (PCT) by 64-slice tomograph (Toshiba Aquilion TSX-101A; Toshiba Medical Systems, Europe BV, Zoetermeer, The Netherlands). PCT was performed 1–12 days after TBI in the first group and 2–8 days after surgical evacuation of the hematoma in the second group. The perfusion examination report included an initial contrast-free CT of the brain [15]. The so-called “area of interest” was established based on areas of middle cerebral artery.
Extended scanning was further performed of four such “areas of interest,” 32 mm in thickness, within 55 s with a contrast agent administered (the brain perfusion mode). The scanning parameters were 120 kVp, 70 mA, 70 mAs, and 1,000 ms. The contrast agent (Ultravist 370, Schering AG, Germany) was administered with an automatic syringe injector (Stellant, Medrad, Indianola, PA, USA) into a peripheral vein through a standard catheter (20 G) at a rate of 4–5 ml/s in a dose of 30–50 ml per one examination.
After scanning, the data volume was transferred to a workstation (Vitrea 2, Vital Imaging, Inc., ver. 4.1.8.0). Artery and vein marks were automatically recorded, followed by the manual control of indices in the time-concentration diagram.
The so-called “area of interest” was established based on subcortical areas of middle cerebral artery. Arteriovenous amplitude of regional cerebral blood volume oscillation (delta cerebral blood volume, ΔCBV) was calculated as the difference between arterial and venous blood volume in the “region of interest” of 1 cm2 [9].
Cerebral blood flow velocity of the middle cerebral artery was recorded bilaterally using transcranial Doppler ultrasound with 2-MHz probes attached with a headband (Sonomed 300 M, Spectromed, Moscow, Russia). Arterial blood pressure was measured noninvasively (MAP 03, Cardex, Moscow, Russia) after PCT.
Statistical Analysis
For the calculation of the time constant, we used the formula proposed by Kasprowicz et al. [9], amended by Czosnyka et al. [4]:
where ampСаВV is the arteriovenous amplitude of regional cerebral blood volume, MAP is mean arterial pressure, Vmean is mean flow velocity rate of middle cerebral artery, and ampABP is amplitude arterial blood pressure. Reference range τ was chosen according Kasprowicz et al. [7] as 0.22 ± 0.06 sec.
The t-test for dependent samples was utilized to analyze differences in means of parameters between the ipsilateral and contralateral sides of the temporal lobes. The program Statistica 7.0 (StatSoft Inc., Tulsa, OK, USA) was used for the analysis. A significance level of p < 0.05 was determined.
Results
Mean values and standard deviations of the data are summarized in Table 2. The cerebrovascular time constant was shorter (p = 0.05) in both the first and second group (with or without traumatic hematomas) in comparison with normal data (p < 0.05). The time constant in the second group was shorter than in the first group, both on the side of the former hematoma (р = 0.012) and on the contralateral side (р = 0.044). Moreover, there was no significant difference in τ between the perifocal zone of the former hematoma and the same locus of the contralateral hemisphere. Also, no significant effects of patient age on the τ value were found (р > 0.05).
Table 2
Comparison of the analyzed parameters
MAP (mm Hg) | ampABP (mm Hg) | Vmean (sm/s) | ΔCBV (sm3) | τ (sec) | ||
|---|---|---|---|---|---|---|
1 | Group 1 | 99.1 ± 13.6 | 63.9 ± 11.7 | 41.1 ± 13.3 | 2.6 ± 0.8 | 0.10 ± 0.02 |
2 | Group 2 (ipsilateral sides)
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