Rapidly progressive brain atrophy in septic ICU patients: a retrospective descriptive study using semiautomatic CT volumetry

Abstract Background Sepsis is often associated with multiple organ failure; however, changes in brain volume with sepsis are not well understood. We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Methods Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included (n = 48). The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group (n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group (n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Results Analysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. second CT scan: 1.002 ± 0.121 L, t (41) = 9.436, p < 0.001). The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm3. The proportion of cases on mechanical ventilation (95.2% vs. 66.7%; p = 0.02) and median time on mechanical ventilation (28 [IQR 15–57] days vs. 15 [IQR 0–25] days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. Conclusions Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.

Download Full-text

What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000717 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000717

Author(s):

Panu Teeratakulpisarn ◽

Phati Angkasith ◽

Thanakorn Wannakul ◽

Parichat Tanmit ◽

Supatcha Prasertcharoensuk ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

High Risk ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Skull Fracture ◽

Brain Ct ◽

Baseline Characteristics ◽

Gcs Score ◽

The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

Download Full-text

How much is the effective dose from medical imaging in pediatric patients in the neurosurgery department?

Radioprotection ◽

10.1051/radiopro/2021014 ◽

2021 ◽

Author(s):

B. Zeinali-Rafsanjani ◽

S. Haseli ◽

R. Jalli ◽

M. Saeedi-Moghadam

Keyword(s):

Medical Imaging ◽

Ionizing Radiation ◽

Ct Scan ◽

Effective Dose ◽

Pediatric Patients ◽

Ct Scans ◽

Imaging Data ◽

Plain Radiographs ◽

Brain Ct ◽

Abdomen Ct

Medical imaging with ionizing radiation in pediatric patients is rising, and their radiation sensitivity is 2–3 times more than adults. The objective of this study was to estimate the total effective dose (ED) of all medical imaging by CT scan and plain radiography in patients in pediatric neurosurgery department. Patients with at least one brain CT scan and recorded dose length product (DLP) were included. Patients’ imaging data were collected from the picture-archiving-and-communicating system (PACS) using their national code to find all their medical imaging. Total ED (mSv) from CT scans and plain radiographs were calculated. A total of 300 patients were included, of which 129 were females and 171 males with a mean age of 5.45 ± 4.34 years. Mean DLPs of brain, abdomen, and chest CT were 329.16, 393.06, 284.46 mGy.cm. The most frequent CT scans in these children were brain CT scans with ED range of 0.09 to 47.09 mSv. Total ED due to all CT scans and plain radiographs were in the range of 0.38 to 63.41 mSv. Although the mean DLP of each brain, chest, and abdomen CT of patients was in the range of DRLs reported by previous studies, the patients with numerous CT scans received more radiation doses than mean ED (6.21 mSv between all age groups). The most frequent CT scan was the brain, and the most frequent plain radiographs were chest and lower extremities. It can be concluded that reducing the number of CT scans or plain radiographs by appropriate physical exams or replacing them with modalities that do not use ionizing radiation can reduce ED.

Download Full-text

Novel Multi-Linear Quantitative Brain Volume Formula For Manual Radiological Evaluation Of Brain Atrophy

10.21203/rs.3.rs-34330/v1 ◽

2020 ◽

Author(s):

Richard Erasto Sungura ◽

Emmanuel Abraham Mpolya ◽

JM Spitsbergen ◽

Callen Kwamboka Onyambu ◽

Elingarami Sauli ◽

...

Keyword(s):

Brain Atrophy ◽

Quantitative Methods ◽

Brain Volume ◽

Northern Tanzania ◽

Alternative Formula ◽

Evans Index ◽

Radiological Measurements ◽

Technical Simplicity ◽

Radiological Methods ◽

The Brain

Abstract Background The brain is a dynamic organ that develops and involutes in volume. The process of volume loss known as brain atrophy commonly occurs in elderly. However, some conditions have been implicated to provoke this paradoxical process in childhood and making it important to have methods and techniques of quantifying brain volume. Automated quantitative methods are very important in brain atrophy assessment but these tools have limited availability in developing countries. The simplified linear radiological methods are poorly reproducible and hence there is a need to develop an alternative formula that is reproducible and applicable at all healthcare levels. Methods The multi-linear diagonal brain fraction formula (DBF) was designed from dimensions of brain relative to skull. To test a developed formula, a total of 347 subjects aged between 0 and 18 years who had brain CT scans performed at the health facilities in Northern Tanzania were recruited and subjected to a systematic measurement of their brains in a diagonal brain fashion. Results Out of 347 patients evaluated, 62 subjects (17.8%) were found to be cases of brain atrophy. The three radiological measurements which included sulcal width (SW), ventricular width (VW) and Evans Index (EI) were concurrently performed. SW and VW showed good age correlation while EI showed no significant correlation with age. Similar tests were extended to diagonal brain fraction (DBF) and skull vertical horizontal ratio (VHR) in which DBF showed significant correlation. Conclusions The DBF formula shows significant ability of differentiating changes of brain volume suggesting that it can be utilized as an alternative brain fraction quantification method bearing technical simplicity in assessing gross brain volume with the ability to classify degrees of brain atrophy into mild, moderate, severe and very severe stages.

Download Full-text

A multi-label classification model for full slice brain computerised tomography image

BMC Bioinformatics ◽

10.1186/s12859-020-3503-0 ◽

2020 ◽

Vol 21 (S6) ◽

Author(s):

Jianqiang Li ◽

Guanghui Fu ◽

Yueda Chen ◽

Pengzhi Li ◽

Bo Liu ◽

...

Keyword(s):

Deep Learning ◽

Ct Images ◽

Image Features ◽

Classification Model ◽

Brain Diseases ◽

Ct Scans ◽

Computerised Tomography ◽

Brain Ct ◽

Proposed Model ◽

The Brain

Abstract Background Screening of the brain computerised tomography (CT) images is a primary method currently used for initial detection of patients with brain trauma or other conditions. In recent years, deep learning technique has shown remarkable advantages in the clinical practice. Researchers have attempted to use deep learning methods to detect brain diseases from CT images. Methods often used to detect diseases choose images with visible lesions from full-slice brain CT scans, which need to be labelled by doctors. This is an inaccurate method because doctors detect brain disease from a full sequence scan of CT images and one patient may have multiple concurrent conditions in practice. The method cannot take into account the dependencies between the slices and the causal relationships among various brain diseases. Moreover, labelling images slice by slice spends much time and expense. Detecting multiple diseases from full slice brain CT images is, therefore, an important research subject with practical implications. Results In this paper, we propose a model called the slice dependencies learning model (SDLM). It learns image features from a series of variable length brain CT images and slice dependencies between different slices in a set of images to predict abnormalities. The model is necessary to only label the disease reflected in the full-slice brain scan. We use the CQ500 dataset to evaluate our proposed model, which contains 1194 full sets of CT scans from a total of 491 subjects. Each set of data from one subject contains scans with one to eight different slice thicknesses and various diseases that are captured in a range of 30 to 396 slices in a set. The evaluation results present that the precision is 67.57%, the recall is 61.04%, the F1 score is 0.6412, and the areas under the receiver operating characteristic curves (AUCs) is 0.8934. Conclusion The proposed model is a new architecture that uses a full-slice brain CT scan for multi-label classification, unlike the traditional methods which only classify the brain images at the slice level. It has great potential for application to multi-label detection problems, especially with regard to the brain CT images.

Download Full-text

Validity of mild TBI risk score to predict intracranial hemorrhage in cases of mild traumatic brain injury in Thailand

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000453 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000453

Author(s):

Kasamon Aramvanitch ◽

Chaiyaporn Yuksen ◽

Chetsadakon Jenpanitpong ◽

Promphet Nuanprom ◽

Yuranan Phootothum ◽

...

Keyword(s):

High Risk ◽

Ct Scan ◽

Intracranial Hemorrhage ◽

Risk Score ◽

Risk Group ◽

Ct Scans ◽

Moderate Risk ◽

Mild Tbi ◽

Brain Ct ◽

Brain Ct Scan

BackgroundPatients with mild traumatic brain injury (TBI) will receive a brain CT scan based on risk of injury. A previous study established a scoring system for patients with mild TBI that assigned <3 points for the low-risk group, 3–6 points for the moderate-risk group, and ≥6 points for the high-risk group. The purpose of this study was to evaluate the external validity of mild TBI risk scores for predicting intracranial hemorrhage in patients with mild TBI who had been transferred to receive a brain CT scan at the 10 nationwide CT scan–capable facilities in Thailand.MethodsThe study was a retrospective cross-sectional review of patients with mild TBI who received a brain CT scan in 10 nationwide hospitals of Thailand. Risk factors were observed and points calculated for predicting mild TBI scores based on patient records. Injured patients were divided into two groups: CT scans indicating normal and abnormal brain images. After this, the accuracy of mild TBI score for predicting the presence of intracranial hemorrhage was investigated.ResultsThe study included a total of 999 patients, comprising 461 (46.15%) patients with abnormal brain CT scans indicating intracranial hemorrhage and 538 (53.85%) indicating no intracranial hemorrhage. In the low-risk group (mild TBI risk score <3), moderate-risk group (mild TBI risk score 3–6), and high-risk group (mild TBI risk score >6), the likelihood ratio positive of brain CT scans were 0.41, 3.53, and 77.3, respectively.DiscussionMild TBI risk score may assist healthcare providers to select patients with mild TBI for brain CT scan referral, particularly in hospitals without CT scan facilities. In such cases, based on the proposed scoring system, immediate transfer of moderate-risk and high-risk patients with mild TBI to a CT scan–capable facility is necessary.

Download Full-text

Abstract WP308: Global Cerebral Edema Among Good Grade Patients with Intracerebral Hemorrhage. Results from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) Study

Stroke ◽

10.1161/str.44.suppl_1.awp308 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Shahram Majidi ◽

Waqas I Gilani ◽

Nauman Tariq ◽

Haitham M Hussein ◽

Yuko Y Palesch ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Scan ◽

Brain Edema ◽

Cerebral Edema ◽

Brain Volume ◽

Prognostic Significance ◽

Ct Scans ◽

Total Brain Volume ◽

Total Brain ◽

Global Brain

INTRODUCTION: There is some evidence that injury and blood brain barrier disruption can be seen in regions distant from the hematoma in patients with intracerebral hemorrhage (ICH). Objective: To ascertain the occurrence of global brain edema in patients with ICH and to explore the relationship between patient characteristics and three month outcomes. Design: A post-hoc analysis of a traditional Phase I dose escalation multicenter prospective study recruited patients with ICH, elevated SBP≥170 mmHg, and Glasgow Coma Scale score ≥8, who presented within 6 hours of symptom onset. Computed tomographic (CT) scans at baseline, 24 hours, and any performed at later intervals were submitted to a core image laboratory. We were able to ascertain the presence and magnitude of global brain edema in 41 of 60 subjects with adequate CT scan resolution. Settings: Emergency departments and intensive care units. Primary Outcomes: We determined the total brain, hematoma, and perihematoma edema volumes from baseline, 24 hour, and 48 hour (if available) CT scans using image analysis software. The global brain edema volume was determined by subtracting the hematoma and perihematomal edema volumes from the total brain volume. Results: A total of 18 (44%) of 41 patients had global cerebral edema that developed between initial CT scan and 24 hour CT scan. The median increase in brain volume among the 18 subjects was 35 cc ranging from 0.12 cc to 296 cc. The baseline GCS score (median 15 versus 15) and hematoma volume (mean±SD; 11.5±10.3 versus 13.9±17) were similar between subjects who experienced global cerebral edema and those who did not. The initial serum glucose was higher among subjects with global cerebral edema (150.5±74.3 mg/dl verus 119.7±34.6 mg/dl). Of the 18 patients who underwent a CT scan at 48 hours, 5 had either new or worsening global cerebral edema. Three of the 18 patients with global cerebral edema underwent neurological deterioration and 1 patient died during hospitalization. Conclusions: Global cerebral edema can occur even in subjects with mild ICH. The pathophysiological basis and prognostic significance needs to be studied in future trials.

Download Full-text

Study protocol for investigating the performance of an automated blood test measuring GFAP and UCH-L1 in a prospective observational cohort of patients with mild traumatic brain injury: European BRAINI study

BMJ Open ◽

10.1136/bmjopen-2020-043635 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043635

Author(s):

Marion Richard ◽

Alfonso Lagares ◽

Victor Bondanese ◽

Javier de la Cruz ◽

Odile Mejan ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Brain Lesions ◽

Ct Scans ◽

Secondary Outcome ◽

Serum Concentrations ◽

Brain Ct ◽

Automated Assay

IntroductionMild traumatic brain injury (mTBI) is a common cause of clinical consultation in the emergency department. Patients with mTBI may undergo brain CT scans based on clinical criteria. However, the proportion of patients with brain lesions on CT is very low. Two serum biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), have been shown to discriminate patients regarding the presence or absence of brain lesions on initial CT scan when assessed within the first 12 hours after TBI. However, the current technique for measuring serum concentrations of GFAP and UCH-L1 is manual and time consuming, which may hinder its use in routine clinical practice. This study assesses the diagnostic accuracy of an automated assay for the measurement of serum GFAP and UCH-L1 in a cohort of patients with mTBI who received a CT scan as the standard of care.Methods and analysisThis is a prospective multicentre observational study of 1760 patients with mTBI recruited in France and Spain across 16 participating sites. Adult patients with an initial Glasgow Coma Scale score of 13–15 and a brain CT scan underwent blood sampling within 12 hours after TBI. The primary outcome measure is the diagnostic performance of an automated assay measuring serum concentrations of GFAP and UCH-L1 for discriminating between patients with positive and negative findings on brain CT-scans. Secondary outcome measures include the performance of these two biomarkers in predicting the neurological status and quality of life at 1 week and 3 months after the trauma.Ethics and disseminationEthics approval was obtained by the Institutional Review Board of Sud-Ouest Outre Mer III in France (Re#2019-A01525-52) and Hospital 12 de Octubre in Spain (Re#19/322). The results will be presented at scientific meetings and published in peer-reviewed publications.Trial registration numberClinicalTrials.gov: NCT04032509.

Download Full-text

The effect of ventilator-associated pneumonia on the prognosis of intensive care unit patients within 90 days and 180 days

BMC Infectious Diseases ◽

10.1186/s12879-021-06383-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenjuan Luo ◽

Rui Xing ◽

Canmin Wang

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Information ◽

Length Of Hospital Stay ◽

Simplified Acute Physiology Score ◽

Serum Lactate ◽

Binary Logistic Regression Analysis ◽

Ventilator Associated Pneumonia ◽

Icu Patients

Abstract Background Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients. Methods Totally, 8182 patients who aged ≥18 years and received mechanical ventilation (MV) in ICU from Medical Information Mart for Intensive Care III (MIMIC III) database were involved in this study. All subjects were divided into the VAP group (n = 537) and the non-VAP group (n = 7626) based on the occurrence of VAP. Clinical data of all participants were collected. The effect of VAP on the prognosis of ICU patients was explored by binary logistic regression analysis. Results The results delineated that the 90-day mortality of VAP patients in ICU was 33.33% and 180-day mortality was 37.62%. The 90-day and 180-day mortality rates were higher in the VAP group than in the non-VAP group. After adjusting the confounders including age, ethnicity, heart failure, septicemia, simplified acute physiology score II (SAPSII) score, sequential organ failure assessment (SOFA) score, serum lactate, white blood cell (WBC), length of ICU stay, length of hospital stay, length of ventilation, antibiotic treatment, Pseudomonas aeruginosa (P.aeruginosa), methicillin-resistant Staphylococcus aureus (MRSA), other pathogens, the risk of 90-day and 180-day mortalities in VAP patients were 1.465 times (OR = 1.465, 95%CI: 1.188–1.807, P < 0.001) and 1.635 times (OR = 1.635, 95%CI: 1.333–2.005, P < 0.001) higher than those in non-VAP patients, respectively. Conclusions Our study revealed that ICU patients with VAP had poorer prognosis than those without VAP. The results of this study might offer a deeper insight into preventing the occurrence of VAP.

Download Full-text

The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.157 ◽

2017 ◽

Vol 5 (6) ◽

pp. 740-743

Author(s):

Ahmet Öğrenci ◽

Orkun Koban ◽

Murat Ekşi ◽

Onur Yaman ◽

Sedat Dalbayrak

Keyword(s):

Ct Scan ◽

Pediatric Patients ◽

Obstructive Hydrocephalus ◽

Hospital Setting ◽

Ct Scans ◽

Time Interval ◽

Clinical Approach ◽

Abnormal Finding ◽

Brain Ct

AIM: This study aimed to make a retrospective analysis of pediatric patients with head traumas that were admitted to one hospital setting and to make an analysis of the patients for whom follow-up CT scans were obtained.METHODS: Pediatric head trauma cases were retrospectively retrieved from the hospital’s electronic database. Patients’ charts, CT scans and surgical notes were evaluated by one of the authors. Repeat CT scans for operated patients were excluded from the total number of repeat CT scans.RESULTS: One thousand one hundred and thirty-eight pediatric patients were admitted to the clinic due to head traumas. Brain CT scan was requested in 863 patients (76%) in the cohort. Follow-up brain CT scans were obtained in 102 patients. Additional abnormal finding requiring surgical intervention was observed in only one patient (isolated 4th ventricle hematoma) on the control CTs (1% of repeat CT scans), who developed obstructive hydrocephalus. None of the patients with no more than 1 cm epidural hematoma in its widest dimension and repeat CT scans obtained 1.5 hours after the trauma necessitated surgery.CONCLUSION: Follow-up CT scans changed clinical approach in only one patient in the present series. When ordering CT scan in the follow-up of pediatric traumas, benefits and harms should be weighted based upon time interval from trauma onset to initial CT scan and underlying pathology.

Download Full-text