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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1642-1652

Brain Perfusion in Children: Evolution With Age Assessed by Quantitative Perfusion Computed Tomography

Max Wintermark, MD^*, Domenico Lepori, MD^*, Jacques Cotting, MD, Eliane Roulet, MD, Guy van Melle, PhD, Reto Meuli, MD, PhD^*, Philippe Maeder, MD^*, Luca Regli, MD^||, Francis R. Verdun, PhD^¶, Thierry Deonna, MD, Pierre Schnyder, MD^* and François Gudinchet, MD^*

^* Department of Diagnostic and Interventional Radiology, University Hospital, Lausanne, Switzerland
Department of Pediatrics, University Hospital, Lausanne, Switzerland
Biostatistics Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland
^|| Department of Neurosurgery, University Hospital, Lausanne, Switzerland
^¶ University Institute of Applied Radiophysics, Lausanne, Switzerland

Objective. The objective of this study was to assess the age-related variations of brain perfusion through quantitative cerebral perfusion computed tomography (CT) results in children without brain abnormality.

Methods. Brain perfusion CT examinations were performed in 77 children, aged 7 days to 18 years. These patients were admitted at our institution for both noncontrast and contrast-enhanced cerebral CT. Only children whose conventional cerebral CT and clinical/radiologic follow-up, including additional investigations, were normal were taken into account for this study (53 of 77).

Results. The average regional rCBF amounts to 40 (mL/100 g per minute) for the first 6 months of life, peaks at 130 (mL/100 g per minute) at 2 to 4 years of age, and finally stabilizes at 50 (mL/100 g per minute) at 7 to 8 years of age, with a small increase of rCBF values at 12 years of age. The rCBF in the gray matter averages 3 times that in the white matter, except for the first 6 months of life. The global CBF represents 10% to 20% of the global cardiac output for the first 6 months of life, peaks at 55% by 2 to 4 years of age, and finally stabilizes at 15% by 7 to 8 years of age. Specific age-related evolution patterns were identified in the different anatomic areas of the cerebral parenchyma, which could be related to the development of neuroanatomic structures and to the emergence of corresponding cognitive functions.

Conclusions. Quantitative perfusion CT characterization of brain perfusion shows specific age variations. Brain perfusion of each cortical area evolves according to a specific time course, in close correlation with the psychomotor development.

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Key Words: child • brain maturation • brain perfusion • psychomotor development • CT • perfusion CT

Abbreviations: MR-PWI, magnetic resonance perfusion-weighted imaging • CT, computed tomography • SPECT, single photon emission computed tomography • PET, positron emission tomography • CBF, cerebral blood flow • MTT, mean transit time • rCBV, regional cerebral blood volume • rCBF, regional cerebral blood flow • ROI, region of interest • BSA, body surface area • ANOVA, analysis of variance • MRI, magnetic resonance imaging

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Received for publication Jun 2, 2003; Accepted Oct 20, 2003.

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