Early Parenchymal Contrast Extravasation Predicts Subsequent Hemorrhage Progression, Clinical Deterioration, and Need for Surgery in Patients With Traumatic Cerebral Contusion

Abstract

Early parenchymal CE is associated with hemorrhage progression, cerebral edema, clinical deterioration, and need for subsequent surgery. These patients should be monitored closely, and early surgery may be needed if deterioration occurs. Further elucidation of the pathophysiology is needed to formulate effective treatment for these high-risk patients.

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

“…A potential major caveat of our finding is the difference in CTA/PCCT acquisition protocols across different centers, which can potentially mitigate the external validity of these results and mandate reproduction in other centers. For example, Huang et al 25 did not identify any CTA-positive extravasation foci; all the observed extravasation foci were identified on the PCCT, and, contrary to our results regarding PCL, PCCT extravasation foci were significantly associated with hemorrhage progression (by using a different threshold of Ͼ5 mL or 30%), clinical deterioration, and the need for surgery. We encountered a slightly higher rate of extravasation per patient (50%) compared with 43% in the study by Huang et al 25 This difference is likely related to the inclusion of extra-axial hematomas in our study, especially epidural hematomas, which showed higher prevalence of extravasation.…”

“…Akin to prior nontraumatic ICH studies [12][13][14][15][16][17][18][20][21][22]38 and a smaller cerebral contusion study, 25 our results demonstrate the prognostic value of contrast extravasation in traumatic intracrananial injuries. Similarly, earlier MR imaging series evaluated "enhancement" of traumatic intra-and extra-axial hematomas, also suggesting a predictive value of extravasation in this setting but were limited by significantly smaller sample sizes.…”

“…These results must, however, be measured against the decreased specificity of extravasation seen on delayed imaging and the overshadowing effect of extravasation identified on CTA (CTA-spot sign) over PCL for hematoma-growth prediction. 15 Irrespective of potentially different pathomechanisms, 15,25,30 the lower predictive value of PCL is likely related to its slower extravasation rate and is consequently associated with a lower risk of significant hematoma expansion, as shown in a recent CT perfusion study. 26 Comparable with these findings, our results showed no prognostic value associated with PCL, though it is possible that we did not have enough statistical power to show a weaker association between PCL and the per-lesion outcomes.…”

“…The relationship of CE and vasogenic edema prediction was also not evaluated but is known to be an important cause of secondary injury 56 and seems to be associated with the presence of contrast extravasation. 25 Long-term prognosis, including Glasgow Outcome Scale scores, was not evaluated, because the focus of this study was primarily the acute in-hospital course. Mortality in trauma patients is often multifactorial.…”

“…A recent study evaluated 22 patients with traumatic cerebral contusions and concluded that early parenchymal CE is associated with clinical progression, cerebral edema, clinical deterioration, and the need for subsequent surgery. 25 The aim of this study was to analyze the value of contrast extravasation for the prediction of hematoma progression or evacuation as well as the prediction of in-hospital mortality. In addition, spontaneous ICH studies have shown the potential importance of assessing the rate of contrast extravasation, which can be grossly estimated by using a biphasic acquisition protocol.…”