The Clinical Value Of Portable Head CT In Neurocritical Patients

Objective To investigate the clinical value of portable head CT in neurocritical patients.Methods 1.In November 2013 to May 2014 we use portable CT scanner to do noncontrast CT scan for 388 neurocritical patients in NICU in our hospital,with traumatic brain injury in 75 cases,brain tumor in 155 cases,cerebrovascular disease in 119 cases,and other in 39 cases,000 cases with complete 1 consecutive times moving head CT scan.This study include the clinical data of 1000 consecutive portable CT scans;According to the history and nursing records and imaging data saved in the portable CT workstation,1000 consecutive portable head CT scans in our hospital's NICU were studied.2.We did portable CT perfusion and noncontrast CT scan at same time to severe traumatic brain injury patients admitted to NICU in our hospital within 24 hours after injury.And reexamined the noncontrast CT scan after 5 days.Made images of CBF,CBV,and MTT respectively and compared the images of CT scans within 24 hours,portable CT perfusion,and CT scans after 5 days.Results 1.The average total time to perform a portable head CT scan was 8.0±2.5min.The actual scan time was 2.5±0.6 min.This study include 75 craniocerebral trauma patients,155 brain tumor patients,119 cerebrovascular disease patients(including spontaneous cerebral hemorrhage,cerebral infarction and subarachnoid hemorrhage),and 39 other patients.Management changes were made after 473(47.3%)of the portable CT scans that were obtained,including the immediately surgical treatment of 27 times(5.7%),to strengthen the dehydration,open ventricular drainage to release cerebrospinal fluid.etc 446 times(94.3%).In this study,patients with unconsciousness(GCS?12)439 times(43.9%),with endotracheal intubation or tracheostomy 227 times(22.7%),need artificial breathing 68 times(6.8%),need to calm treatment 132 times(13.2%).No scans were complicated by accidental disconnection of a pipe line.2.This study included 26 patients with severe brain trauma,mean age 38.7 ± 16.8 years,including 15 men and 11 women,mean GCS 6.3±1.9,Intracranial pressure(ICP)monitored in 18(69%).Findings of noncontrast CT scan:mainly cerebral contusion in 16 cases(62%),mainly epidural/subdural hematoma in 7 cases(26%),mainly diffuse axonal injury in 3 cases(12%).CTP was performed 15.6±4h from trauma.The area of altered perfusion was larger than the injured area detected by simultaneous noncontrast CT in 16(62%).The degree of hypoperfusion was found to be in the severe range on quantitative assessment in 7 patients(27%).The clinical management was altered by these CTP findings in three patients(12%),in whom massive and unsurvivable strokes were identified,despite minimal changes on both arrival and simultaneous noncontrast CT san.Compared with simultaneous CT scan,the CTP have better correlation with the CT scan after 5 days.Conclusion 1.Portable CT can provide reliable imaging diagnosis in time for the critically ill patients in NICU and provide a strong basis for clinical intervention,easy to use,and safe.2.Ischemia exists in the early period of TBI,and have high incidence.Portable CT perfusion scan can make relatively accurate assessment of the situation of cerebral perfusion in patients with severe traumatic brain injury in early period after injury,provide powerful basis for clinical intervention.