Imaging of cerebral blood flow and metabolism in brain injury in the ICU.
Pickard JD., Hutchinson PJ., Coles JP., Steiner LA., Johnston AJ., Fryer TD., Coleman MR., Smielewski P., Chatfield DA., Aigbirhio F., Williams GB., Rice K., Clark JC., Salmond CH., Sahakian BJ., Bradley PG., Carpenter TA., Salvador R., Pena A., Gillard JH., Cunningham AS., Piechnik S., Czosnyka M., Menon DK.
The heterogeneity of the initial insult and subsequent pathophysiology has made both the study of human head injury and design of randomised controlled trials exceptionally difficult. The combination of multimodality bedside monitoring and functional brain imaging positron emission tomography (PET) and magnetic resonance (MR), incorporated within a Neurosciences Critical Care Unit, provides the resource required to study critically ill patients after brain injury from initial ictus through recovery from coma and rehabilitation to final outcome. Methods to define cerebral ischemia in the context of altered cerebral oxidative metabolism have been developed, traditional therapies for intracranial hypertension re-evaluated and bedside monitors cross-validated. New modelling and analytical approaches have been developed.