Contusion Contrast Extravasation Depicted on Multidetector Computed Tomography Angiography Predicts Growth and Mortality in Traumatic Brain Contusion

Abstract

Traumatic brain injury (TBI) is the main cause of death in trauma victims and causes high rates of disability and neurological sequelae. Approximately 38-65% of traumatic brain contusions (TBC) demonstrate hemorrhagic expansion on serial computed tomography (CT) scans. Thus far, however, no single variable can accurately predict the hemorrhage expansion of a TBC. Our purpose was to evaluate contrast extravasation (CE) as a predictor of expansion, mortality, and poor outcome in TBC in a Brazilian cohort. After Institutional Review Board approval, we used multidetector CT angiography (MDCTA) to study 121 consecutive patients (106 men, 87.6%) with ages varying from 10 to 85 years. Informed consent was obtained from all subjects. The clinical and imaging findings were correlated with the findings on the initial MDCTA using either the Fisher exact test or Student t test and a multivariate logistic regression model. Of the persons who presented CE in TBC, 21.8% died (in-hospital mortality), whereas in the absence of this sign, the mortality rate was 7.6% (p = 0.014). In addition, expansion of the hemorrhagic component of the TBC was detected in 61.1% of the CE-positive patients, whereas expansion was only observed in 10% of the CE-negative patients (p < 0.001). Poor outcome was observed in 24.2% of the patients in the CE-negative group, but in the presence of CE, 72.7% evolved with poor outcome (p < 0.001). The CE was a strong independent predictor of expansion, poor outcome, and increased risk of in-hospital mortality in our series of patients with TBC.

Quantification of Iodine Leakage on Dual-Energy CT as a Marker of Blood-Brain Barrier Permeability in Traumatic Hemorrhagic Contusions: Prediction of Surgical Intervention for Intracranial Pressure Management

“…Studies have shown a correlation between the presence of iodine leak with HPC and craniectomies after TBI. [11][12][13][14] In contrast to previous studies, our results did not show a correlation between leaked iodine concentration and craniectomy, but they correlated with surgical ICP management. This difference might be due to qualitative assessment of images on SECT and by using various threshold levels of Hounsfield units to confirm leaks.…”

“…There are reports of CT identification of contrast leakage caused by BBB disruption in cerebral contusions that depend on qualitative assessment of iodine leakage following CTA of the brain. [11][12][13][14] These studies performed on single-energy CT (SECT) showed a correlation between iodine leakage and hemorrhagic progression of contusions (HPC). [11][12][13][14] Although CTA for evaluating TBI is not an accepted standard of care, contrast-enhanced whole-body CT (WBCT) is widely used in the work-up of patients with polytrauma.…”

“…[11][12][13][14] These studies performed on single-energy CT (SECT) showed a correlation between iodine leakage and hemorrhagic progression of contusions (HPC). [11][12][13][14] Although CTA for evaluating TBI is not an accepted standard of care, contrast-enhanced whole-body CT (WBCT) is widely used in the work-up of patients with polytrauma. 15 The contrast bolus administered during the admission WBCT leaks into and is retained in the epicenter and penumbra of hemorrhagic contusion due to capillary fragmentation and BBB disruption.…”

The extravasation of contrast as a predictor of cerebral hemorrhagic contusion expansion, poor neurological outcome and mortality after traumatic brain injury: A systematic review and meta-analysis

“…The next study was developed by Rosa Jr et al in 2016 [37]. On a cohort of 121 patients, they investigated whether the contrast extravasation was a predictor of hematoma expansion (available on 96 patients), poor outcomes and mortality in traumatic brain hemorrhagic lesions.…”

In Vivo Photoacoustic Imaging of Brain Injury and Rehabilitation by High‐Efficient Near‐Infrared Dye Labeled Mesenchymal Stem Cells with Enhanced Brain Barrier Permeability

“…Several deficits in memory, attention, language, problems solving, and academic skills, and motor functions are among the most common and disabling symptoms of TBI patients 2, 3. There are numerous methods such as, functional magnetic resonance imaging,4 and computed tomography (CT) to diagnose and monitor the craniocerebral injury and its self‐recovery 5. However, magnetic resonance imaging (MRI) is only sensitive to deoxyhemoglobin and time‐consuming, preventing it from performing timely therapy monitoring 6.…”