Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Abstract

We conclude that diffuse enhancement indicates extravasation from broken vessels that continue to bleed and that diffusely enhancing hematomas will be rapidly enlarged. We think that postcontrast MRI can be very useful for predicting the progression of acute EDHs and SDHs.

Pure Subdural Hematomas

“…It seems justified to suppose that the dynamics of subdural bleeding vary according to the type of vessel affected. Different patterns of hematoma development (enlargement rates of hemorrhage) have been confirmed with respect to hematoma densities present on initial computed tomographic scans (18), and one might ask whether these were partly caused by different types of injured vessels. The possible influence of the bleeding point on the prognosis or the prediction of the outcome of SDHs is worthy of further analysis.…”

Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth

“…16,56 Such bleeding has been found at craniotomy from bridging veins, cortical arteries, or from contused brain tissue. 16,56 An autopsy series of patients who died of "pure" SDHs was reported by Maxeiner and Wolff. 34 Interestingly, the volumes of "pure" ASDHs from venous or arterial origin did not significantly differ.…”

Three-dimensional computerized tomography angiography in patients with hyperacute intracerebral hemorrhage

“…On MR images obtained in the hyperacute stage, hematomas show a signal intensity essentially similar to that of cerebral parenchyma, so contrast medium extravasation can be visualized easily as a high-intensity area on T 1 -weighted images. 28,33 Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MR imaging reflects the extravasation component more selectively than enhancement from an iodinated contrast agent on CT scans because of the "flow void" phenomenon, which obscures Gd-DTPA in vessels with relatively high flow. Whereas 3D-CT angiography can be used to visualize areas of extravasation as well as the vasculature, Gd-DTPA-enhanced MR imaging would not display the vasculature because of the flow void phenomenon.…”