Computed Tomography Cerebral Perfusion to Predict Functional Outcome in Pediatric Head Injury: A Comparative Study of Voxel-Based and Whole-Brain Perfusion.

Abstract

This study evaluates the extent of perfusion abnormalities in pediatric patients with traumatic head injury by using computed tomography (CT) perfusion (CTP) and compares the efficacy of voxel-based and whole-brain perfusion data clinically with the functional outcome scales Glasgow Outcome Scale Extended-Pediatric Revision and modified Rankin Scale (mRS). In this prospective study, 100 eligible patients aged 0-15 years were enrolled. Patients were categorized into having mild, moderate, and severe traumatic brain injury using the Glasgow Coma Scale. CTP scans were performed at admission and at the time of discharge. Both voxel-based and whole-brain perfusion data were acquired at 5 regions of interest: orbitofrontal cortex, internal capsule, thalamus, caudate nucleus, and sensorimotor cortex for cerebral blood perfusion. The extent of perfusion abnormalities was noted in CTP scans. The Glasgow Outcome Scale Extended-Pediatric Revision and modified Rankin Scale were used to clinically evaluate functional outcomes. Significant differences in CTP findings between voxel-based and whole-brain approaches were noted. Voxel-based scans showed superior predictive value in severe cases, whereas whole-brain scans were promising in moderate cases. Glasgow Coma Scale scores and specific CT parameters (cerebral blood flow and mean transit time.) were also significant predictors of outcomes. The comparative analysis highlights the complementary roles of voxel-based and whole-brain perfusion CT in predicting functional outcomes in pediatric patients with head injury. Clinicians should consider both approaches when evaluating cerebral perfusion status and making treatment decisions. Further research is warranted to validate these findings and refine imaging protocols to optimize predictive accuracy in this vulnerable population.