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

Abstract

BACKGROUND AND PURPOSE: Hemorrhagic contusions are associated with iodine leakage. We aimed to identify quantitative iodine-based dual-energy CT variables that correlate with the type of intracranial pressure management. MATERIALS AND METHODS: Consecutive patients with contusions from May 2016 through January 2017 were retrospectively analyzed. Radiologists, blinded to the outcomes, evaluated CT variables from unenhanced admission and short-term follow-up head dualenergy CT scans obtained after contrast-enhanced whole-body CT. Treatment intensity of intracranial pressure was broadly divided into 2 groups: those managed medically and those managed surgically. Univariable analysis followed by logistic regression was used to develop a prediction model. RESULTS: The study included 65 patients (50 men; median age, 48 years; Q 1 to Q 3 , 25-65.5 years). Twenty-one patients were managed surgically (14 by CSF drainage, 7 by craniectomy). Iodine-based variables that correlated with surgical management were higher iodine concentration, pseudohematoma volume, iodine quantity in pseudohematoma, and iodine quantity in contusions. The regression model developed after inclusion of clinical variables identified 3 predictor variables: postresuscitation Glasgow Coma Scale (adjusted OR = 0.55; 95% CI, 0.38-0.79; P = .001), age (adjusted OR = 0.9; 95% CI, 0.85-0.97; P = .003), and pseudohematoma volume (adjusted OR = 2.05; 95% CI, 1.1-3.77; P = .02), which yielded an area under the curve of 0.96 in predicting surgical intracranial pressure management. The 2 predictors for craniectomy were age (adjusted OR = 0.89; 95% CI, 0.81-0.99; P = .03) and pseudohematoma volume (adjusted OR = 1.23; 95% CI, 1.03-1.45; P = .02), which yielded an area under the curve of 0.89. CONCLUSIONS: Quantitative iodine-based parameters derived from follow-up dual-energy CT may predict the intensity of intracranial pressure management in patients with hemorrhagic contusions. ABBREVIATIONS: AOR 4 adjusted OR; DECT 4 dual-energy CT; HPC 4 hemorrhagic progression of contusion; ICP 4 intracranial pressure; P-GCS 4 postresuscitation Glasgow Coma Scale; SECT 4 single-energy CT; TBI 4 traumatic brain injury; WBCT 4 whole-body CT O ne of the most severe pathoanatomic types of traumatic brain injury (TBI) is hemorrhagic contusion, usually complicated by secondary injury, resulting in cerebral edema leading

Quantitative Intracerebral Iodine Extravasation in Risk Stratification for Intracranial Hemorrhage in Patients with Acute Ischemic Stroke

“…16 Quantitative iodine parameters, including stroke, trauma, metastases, tumors, and perfusion, have been widely used in clinical practice. 12,[17][18][19][20][21][22] Bonatti et al 12 examined patients with acute ischemic stroke undergoing MT with DECT and reported an absolute iodine concentration of .1.35 mg I/mL in the maximum apparent attenuation area, thereby achieving a sensitivity of 100% and specificity of 67.5% in predicting ICH development. Our study also showed a significant difference in iodine concentration in postprocedural DECT between the 2 groups with and without ICH development, with a cutoff value of 2.7 mg I/mL.…”

A Review of the Applications of Dual-Energy CT in Acute Neuroimaging

“…In patients with traumatic parenchymal hemorrhage, iodine quantification methods within the hematoma as a measure of blood–brain barrier permeability have been found to be the best CT predictors of need for decompression craniectomy as well as short-term outcome measures and inpatient mortality. 67,68 However, these DECT techniques did not outperform simple Glasgow Coma Scale for outcome prediction, and future studies correcting for initial Glasgow Coma Scale with more long-term outcome measures are warranted to prospectively validate the prognostic potential of DECT in patients with traumatic brain injury.…”