Skip to main content
Top
Published in: Intensive Care Medicine 8/2005

01-08-2005 | Original

A quantitative computed tomography assessment of brain weight, volume, and specific gravity in severe head trauma

Authors: Thomas Lescot, Marie-Pierre Bonnet, Abederrezak Zouaoui, Jean-Charles Muller, Catalin Fetita, Pierre Coriat, Louis Puybasset

Published in: Intensive Care Medicine | Issue 8/2005

Login to get access

Abstract

Background

Computed tomography DICOM images analysis allows a quantitative measurement of organ weight, volume and specific gravity in humans.

Methods

The brain weight, volume and specific gravity of 15 traumatic brain-injury patients (3±2 days after trauma) were computed using a specially designed software (BrainView). Data were compared with those obtained from 15 healthy subjects paired for age and overall intracranial volume.

Results

Hemisphere weight were 91 g higher in patients than in controls (1167±101 vs 1076±112 g; p<0.05). Specific gravity of hemispheres (1.0367±0.0017 vs 1.0335±0.0012 g/ml; p<0.001), brainstem (1.0302±0.0016 vs 1.0277±0.0015 g/ml; p<0.001) and cerebellum (1.0396±0.0020 vs 1.0375±0.0015 g/ml; p<0.05) was significantly higher in traumatic brain injury (TBI) patients than in controls (all p<0.0001 without interaction). This increase in specific gravity was evenly distributed between the hemispheres, the brainstem and the cerebellum, and the grey and white matter. It was more pronounced in the rostral than in the caudal areas of the hemispheres. It was independent of the volume of brain contusion, of the mechanism of head injury, of natremia and of initial Glasgow coma score.

Conclusion

Human TBI patients present a diffuse increase in specific gravity. This observation is in sharp opposition with the data derived from the experimental literature.
Literature
1.
go back to reference Phelps ME, Gado MH, Hoffman EJ (1975) Correlation of effective atomic number and electron density with attenuation coefficients measured with polychromatic X-rays. Radiology 117:585–588PubMed Phelps ME, Gado MH, Hoffman EJ (1975) Correlation of effective atomic number and electron density with attenuation coefficients measured with polychromatic X-rays. Radiology 117:585–588PubMed
2.
go back to reference Mull RT (1984) Mass estimates by computed tomography: physical density from CT numbers. Am J Radiol 143:1101–1104 Mull RT (1984) Mass estimates by computed tomography: physical density from CT numbers. Am J Radiol 143:1101–1104
3.
go back to reference Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intensive Care Med 26:1215–1227CrossRefPubMed Puybasset L, Gusman P, Muller JC, Cluzel P, Coriat P, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. III. Consequences for the effects of positive end-expiratory pressure. CT Scan ARDS Study Group. Adult Respiratory Distress Syndrome. Intensive Care Med 26:1215–1227CrossRefPubMed
4.
go back to reference Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med 26:857–869CrossRefPubMed Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med 26:857–869CrossRefPubMed
5.
go back to reference Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q and Grenier P (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS Severity Score. CT Scan ARDS Study Group. Intensive Care Med 26:1046–1056CrossRefPubMed Rouby JJ, Puybasset L, Cluzel P, Richecoeur J, Lu Q and Grenier P (2000) Regional distribution of gas and tissue in acute respiratory distress syndrome. II. Physiological correlations and definition of an ARDS Severity Score. CT Scan ARDS Study Group. Intensive Care Med 26:1046–1056CrossRefPubMed
6.
go back to reference Vieira SR, Puybasset L, Richecoeur J, Lu Q, Cluzel P, Gusman PB, Coriat P, Rouby JJ (1998) A lung computed tomographic assessment of positive end-expiratory pressure-induced lung overdistension. Am J Respir Crit Care Med 158:1571–1577PubMed Vieira SR, Puybasset L, Richecoeur J, Lu Q, Cluzel P, Gusman PB, Coriat P, Rouby JJ (1998) A lung computed tomographic assessment of positive end-expiratory pressure-induced lung overdistension. Am J Respir Crit Care Med 158:1571–1577PubMed
7.
go back to reference Vieira SR, Puybasset L, Lu Q, Richecoeur J, Cluzel P, Coriat P and Rouby JJ (1999) A scanographic assessment of pulmonary morphology in acute lung injury. Significance of the lower inflection point detected on the lung pressure-volume curve. Am J Respir Crit Care Med 159:1612–1623PubMed Vieira SR, Puybasset L, Lu Q, Richecoeur J, Cluzel P, Coriat P and Rouby JJ (1999) A scanographic assessment of pulmonary morphology in acute lung injury. Significance of the lower inflection point detected on the lung pressure-volume curve. Am J Respir Crit Care Med 159:1612–1623PubMed
8.
go back to reference Malbouisson LM, Muller JC, Constantin JM, Lu Q, Puybasset L, Rouby JJ (2001) Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1444–1450PubMed Malbouisson LM, Muller JC, Constantin JM, Lu Q, Puybasset L, Rouby JJ (2001) Computed tomography assessment of positive end-expiratory pressure-induced alveolar recruitment in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1444–1450PubMed
9.
go back to reference Malbouisson LM, Busch CJ, Puybasset L, Lu Q, Cluzel P, Rouby JJ (2000) Role of the heart in the loss of aeration characterizing lower lobes in acute respiratory distress syndrome. CT Scan ARDS Study Group. Am J Respir Crit Care Med 161:2005–2012PubMed Malbouisson LM, Busch CJ, Puybasset L, Lu Q, Cluzel P, Rouby JJ (2000) Role of the heart in the loss of aeration characterizing lower lobes in acute respiratory distress syndrome. CT Scan ARDS Study Group. Am J Respir Crit Care Med 161:2005–2012PubMed
10.
go back to reference Lu Q, Malbouisson LM, Mourgeon E, Goldstein I, Coriat P, Rouby JJ (2001) Assessment of PEEP-induced reopening of collapsed lung regions in acute lung injury: are one or three CT sections representative of the entire lung? Intensive Care Med 27:1504–1510CrossRefPubMed Lu Q, Malbouisson LM, Mourgeon E, Goldstein I, Coriat P, Rouby JJ (2001) Assessment of PEEP-induced reopening of collapsed lung regions in acute lung injury: are one or three CT sections representative of the entire lung? Intensive Care Med 27:1504–1510CrossRefPubMed
11.
go back to reference Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814PubMed Gattinoni L, Pelosi P, Crotti S, Valenza F (1995) Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med 151:1807–1814PubMed
12.
go back to reference Pelosi P, D’andrea L, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13PubMed Pelosi P, D’andrea L, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13PubMed
13.
go back to reference Pelosi P, Crotti S, Brazzi L, Gattinoni L (1996) Computed tomography in adult respiratory distress syndrom: What has it taught us? Eur Respir J 9:1055–1062CrossRefPubMed Pelosi P, Crotti S, Brazzi L, Gattinoni L (1996) Computed tomography in adult respiratory distress syndrom: What has it taught us? Eur Respir J 9:1055–1062CrossRefPubMed
14.
go back to reference Pelosi P, Cereda M, Foti G, Giacommi M, Pesenti A (1995) Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med 152:531–537PubMed Pelosi P, Cereda M, Foti G, Giacommi M, Pesenti A (1995) Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med 152:531–537PubMed
15.
go back to reference Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, Karimi A, Lapierre F, Murray G, Ohman J, Persson L, Servadei F, Stocchetti N, Unterberg A (1997) EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 139:286–294 Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, Karimi A, Lapierre F, Murray G, Ohman J, Persson L, Servadei F, Stocchetti N, Unterberg A (1997) EBIC-guidelines for management of severe head injury in adults. European Brain Injury Consortium. Acta Neurochir (Wien) 139:286–294
16.
go back to reference Malbouisson LM, Preteux F, Puybasset L, Grenier P, Coriat P, Rouby JJ (2001) Validation of a software designed for computed tomographic (CT) measurement of lung water. Intensive Care Med 27:602–608CrossRefPubMed Malbouisson LM, Preteux F, Puybasset L, Grenier P, Coriat P, Rouby JJ (2001) Validation of a software designed for computed tomographic (CT) measurement of lung water. Intensive Care Med 27:602–608CrossRefPubMed
17.
go back to reference Unger E, Littlefield J, Gado M (1988) Water content and water structure in CT and MR signal changes: possible influence in detection of early stroke. Am J Neuroradiol 9:687–691PubMed Unger E, Littlefield J, Gado M (1988) Water content and water structure in CT and MR signal changes: possible influence in detection of early stroke. Am J Neuroradiol 9:687–691PubMed
18.
go back to reference Rieth KG, Fujiwara K, Chiro G di, Klatzo I, Brooks RA, Johnston GS, O’Connor CM, Mitchell LG (1980) Serial measurements of CT attenuation and specific gravity in experimental cerebral edema. Radiology 135:343–348PubMed Rieth KG, Fujiwara K, Chiro G di, Klatzo I, Brooks RA, Johnston GS, O’Connor CM, Mitchell LG (1980) Serial measurements of CT attenuation and specific gravity in experimental cerebral edema. Radiology 135:343–348PubMed
19.
go back to reference Torack RM, Alcala H, Gado M, Burton R (1976) Correlative assay of computerized cranial tomography CCT, water content and specific gravity in normal and pathological postmortem brain. J Neuropathol Exp Neurol 35:385–392PubMed Torack RM, Alcala H, Gado M, Burton R (1976) Correlative assay of computerized cranial tomography CCT, water content and specific gravity in normal and pathological postmortem brain. J Neuropathol Exp Neurol 35:385–392PubMed
20.
go back to reference Bullock R, Smith R, Favier J, du Trevou M, Blake G (1985) Brain specific gravity and CT scan density measurements after human head injury. J Neurosurg 63:64–68PubMed Bullock R, Smith R, Favier J, du Trevou M, Blake G (1985) Brain specific gravity and CT scan density measurements after human head injury. J Neurosurg 63:64–68PubMed
21.
go back to reference Takagi H, Shapiro K, Marmarou A, Wisoff H (1981) Microgravimetric analysis of human brain tissue: correlation with computerized tomography scanning. J Neurosurg 54:797–801PubMed Takagi H, Shapiro K, Marmarou A, Wisoff H (1981) Microgravimetric analysis of human brain tissue: correlation with computerized tomography scanning. J Neurosurg 54:797–801PubMed
22.
go back to reference Abbott AH, Netherway DJ, Niemann DB, Clark B, Yamamoto M, Cole J, Hanieh A, Moore MH, David DJ (2000) CT-determined intracranial volume for a normal population. J Craniofac Surg 11:211–223PubMed Abbott AH, Netherway DJ, Niemann DB, Clark B, Yamamoto M, Cole J, Hanieh A, Moore MH, David DJ (2000) CT-determined intracranial volume for a normal population. J Craniofac Surg 11:211–223PubMed
23.
go back to reference Courchesne E, Chisum HJ, Townsend J, Cowles A, Covington J, Egaas B, Harwood M, Hinds S, Press GA (2000) Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology 216:672–682PubMed Courchesne E, Chisum HJ, Townsend J, Cowles A, Covington J, Egaas B, Harwood M, Hinds S, Press GA (2000) Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology 216:672–682PubMed
24.
go back to reference Edland SD, Xu Y, Plevak M, O’Brien P, Tangalos EG, Petersen RC, Jack CR Jr (2002) Total intracranial volume: normative values and lack of association with Alzheimer’s disease. Neurology 59:272–274PubMed Edland SD, Xu Y, Plevak M, O’Brien P, Tangalos EG, Petersen RC, Jack CR Jr (2002) Total intracranial volume: normative values and lack of association with Alzheimer’s disease. Neurology 59:272–274PubMed
25.
go back to reference Ho KC, Roessmann U, Straumfjord JV, Monroe G (1980) Analysis of brain weight. I. Adult brain weight in relation to sex, race, and age. Arch Pathol Lab Med 104:635–639PubMed Ho KC, Roessmann U, Straumfjord JV, Monroe G (1980) Analysis of brain weight. I. Adult brain weight in relation to sex, race, and age. Arch Pathol Lab Med 104:635–639PubMed
26.
go back to reference Ho KC, Roessmann U, Straumfjord JV, Monroe G (1980) Analysis of brain weight. II. Adult brain weight in relation to body height, weight, and surface area. Arch Pathol Lab Med 104:640–645PubMed Ho KC, Roessmann U, Straumfjord JV, Monroe G (1980) Analysis of brain weight. II. Adult brain weight in relation to body height, weight, and surface area. Arch Pathol Lab Med 104:640–645PubMed
27.
go back to reference Bigler ED, Johnson SC, Blatter DD (1999) Head trauma and intellectual status: relation to quantitative magnetic resonance imaging findings. Appl Neuropsychol 6:217–225PubMed Bigler ED, Johnson SC, Blatter DD (1999) Head trauma and intellectual status: relation to quantitative magnetic resonance imaging findings. Appl Neuropsychol 6:217–225PubMed
28.
go back to reference Henry-Feugeas MC, Azouvi P, Fontaine A, Denys P, Bussel B, Maaz F, Samson Y, Schouman-Claeys E (2000) MRI analysis of brain atrophy after severe closed-head injury: relation to clinical status. Brain Inj 14:597–604CrossRefPubMed Henry-Feugeas MC, Azouvi P, Fontaine A, Denys P, Bussel B, Maaz F, Samson Y, Schouman-Claeys E (2000) MRI analysis of brain atrophy after severe closed-head injury: relation to clinical status. Brain Inj 14:597–604CrossRefPubMed
29.
go back to reference Verger K, Junque C, Levin HS, Jurado MA, Perez-Gomez M, Bartres-Faz D, Barrios M, Alvarez A, Bartumeus F, Mercader JM (2001) Correlation of atrophy measures on MRI with neuropsychological sequelae in children and adolescents with traumatic brain injury. Brain Inj 15:211–221CrossRefPubMed Verger K, Junque C, Levin HS, Jurado MA, Perez-Gomez M, Bartres-Faz D, Barrios M, Alvarez A, Bartumeus F, Mercader JM (2001) Correlation of atrophy measures on MRI with neuropsychological sequelae in children and adolescents with traumatic brain injury. Brain Inj 15:211–221CrossRefPubMed
30.
go back to reference Kita H, Marmarou A (1994) The cause of acute brain swelling after the closed head injury in rats. Acta Neurochir Suppl (Wien) 60:452–455 Kita H, Marmarou A (1994) The cause of acute brain swelling after the closed head injury in rats. Acta Neurochir Suppl (Wien) 60:452–455
31.
go back to reference Marmarou A, Fatouros PP, Barzo P, Portella G, Yoshihara M, Tsuji O, Yamamoto T, Laine F, Signoretti S, Ward JD, Bullock MR, Young HF (2000) Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients. J Neurosurg 93:183–193 Marmarou A, Fatouros PP, Barzo P, Portella G, Yoshihara M, Tsuji O, Yamamoto T, Laine F, Signoretti S, Ward JD, Bullock MR, Young HF (2000) Contribution of edema and cerebral blood volume to traumatic brain swelling in head-injured patients. J Neurosurg 93:183–193
32.
go back to reference Kuhl DE, Alavi A, Hoffman EJ, Phelps ME, Zimmerman RA, Obrist WD, Bruce DA, Greenberg JH, Uzzell B (1980) Local cerebral blood volume in head-injured patients. Determination by emission computed tomography of 99mTc-labeled red cells. J Neurosurg 52:309–320PubMed Kuhl DE, Alavi A, Hoffman EJ, Phelps ME, Zimmerman RA, Obrist WD, Bruce DA, Greenberg JH, Uzzell B (1980) Local cerebral blood volume in head-injured patients. Determination by emission computed tomography of 99mTc-labeled red cells. J Neurosurg 52:309–320PubMed
33.
go back to reference Blacque-Belair A, Mathieu de Fossey B, Fourestier M (1965) Dictionnaire des constantes biologiques et physiques. Paris Blacque-Belair A, Mathieu de Fossey B, Fourestier M (1965) Dictionnaire des constantes biologiques et physiques. Paris
34.
go back to reference Talmor D, Shapira Y, Artru AA, Gurevich B, Merkind V, Katchko L, Reichenthal E (1998) 0.45% saline and 5% dextrose in water, but not 0.9% saline or 5% dextrose in 0.9% saline, worsen brain edema two hours after closed head trauma in rats. Anesth Analg 86:1225–1229CrossRefPubMed Talmor D, Shapira Y, Artru AA, Gurevich B, Merkind V, Katchko L, Reichenthal E (1998) 0.45% saline and 5% dextrose in water, but not 0.9% saline or 5% dextrose in 0.9% saline, worsen brain edema two hours after closed head trauma in rats. Anesth Analg 86:1225–1229CrossRefPubMed
35.
go back to reference Gardenfors A, Nilsson F, Skagerberg G, Ungerstedt U, Nordstrom CH (2002) Cerebral physiological and biochemical changes during vasogenic brain oedema induced by intrathecal injection of bacterial lipopolysaccharides in piglets. Acta Neurochir (Wien) 144:601–609 Gardenfors A, Nilsson F, Skagerberg G, Ungerstedt U, Nordstrom CH (2002) Cerebral physiological and biochemical changes during vasogenic brain oedema induced by intrathecal injection of bacterial lipopolysaccharides in piglets. Acta Neurochir (Wien) 144:601–609
36.
go back to reference Nath F, Galbraith S (1986) The effect of mannitol on cerebral white matter water content. J Neurosurg 65:41–43PubMed Nath F, Galbraith S (1986) The effect of mannitol on cerebral white matter water content. J Neurosurg 65:41–43PubMed
37.
go back to reference Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9 [Suppl 1]:S287–S292PubMed Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9 [Suppl 1]:S287–S292PubMed
Metadata
Title
A quantitative computed tomography assessment of brain weight, volume, and specific gravity in severe head trauma
Authors
Thomas Lescot
Marie-Pierre Bonnet
Abederrezak Zouaoui
Jean-Charles Muller
Catalin Fetita
Pierre Coriat
Louis Puybasset
Publication date
01-08-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-2709-y

Other articles of this Issue 8/2005

Intensive Care Medicine 8/2005 Go to the issue

Correspondence

Authors’ reply