Reliability of cranial CT versus intracerebral pressure measurement for the evaluation of generalised cerebral oedema in children

Abstract

Objective. To examine the extent to which intracranial pressure (ICP) in children after severe brain trauma can be determined by cranial CT.¶Materials and methods. Two experienced paediatric radiologists, without any knowledge of the clinical symptoms, evaluated 124 CT scans from 65 children (average age 5.4 years) who underwent intracranial measurement of their cerebral pressure.¶Results. CT had high sensitivity (99.1 %) for ’high cerebral pressure' but a much lower specificity (78.1 %). The examiners tended to estimate ICP as ’high' even when actual ICP was low. Since therapy for lowering cerebral pressure involves potential risks, actual cerebral pressure measurement, particularly in children, should be considered before intervention (e. g. hyperventilation or trepanation). We report the change in different intracerebral fluid compartments with varying cerebral pressure and modifications of the density of the brain tissue in an inter- and intraobserver comparison.¶Conclusion. The radiologist cannot differentiate, for methodological reasons, between a change in the intracranial fluid compartments not associated with a change in ICP and one in which it is critically elevated. Before any interventional treatments such as decompression-trepanation or hyperventilation are instituted, measurement of ICP should be considered, especially in children.