title: Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion.
abstract: BACKGROUND
  This study aimed to identify early radiologic signs that are predictive of hemorrhage progression and clinical deterioration in patients with traumatic cerebral contusion. We hypothesized that contrast extravasation (CE) and blood-brain barrier disruption might be associated with hemorrhage progression, brain edema, and clinical deterioration in these patients.
  
  
  METHODS
  Twenty-two patients with traumatic cerebral contusion (diagnosed on initial noncontrast head computed tomography [CT]) who initially did not require surgical intervention were enrolled in this study. Contrast-enhanced and perfusion CT scans were performed within 6 hours of injury, and follow-up noncontrast CT scans were performed at 24 hours and 72 hours.
  
  
  RESULTS
  In each noncontrast CT scan, the volumes of the contusion hemorrhage and edema were calculated using computerized planimetric techniques. The initial Glasgow Coma Scale, hemorrhage progression, clinical deterioration, and the need for subsequent surgery were recorded. The early radiologic findings were compared with these parameters and functional outcome at 6 months to identify predictive radiologic signs. CE was present in 9 of 22 patients (41%) and was highly associated with hemorrhage progression (p < 0.05), clinical deterioration (p < 0.01), and need for subsequent surgery (p < 0.01). In addition, patients with CE had a greater volume of edema at 24 hours (p < 0.01) and 72 hours (p < 0.01) than those who did not have CE. However, CE was not found to be associated with poor outcome.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Abel Po-Hao
authors.initials: AP
authors.lastname: Huang
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Lee
authors.forename: Hong-Jen
authors.initials: HJ
authors.lastname: Hsieh
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Yang
authors.forename: Yi-Hsin
authors.initials: YH
authors.lastname: Tsai
authors.forename: Fon-Yih
authors.initials: FY
authors.lastname: Tsuang
authors.forename: Lu-Ting
authors.initials: LT
authors.lastname: Kuo
authors.forename: Yuan-Shen
authors.initials: YS
authors.lastname: Chen
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
authors.forename: Hon-Man
authors.initials: HM
authors.lastname: Liu
authors.forename: Jui-Chang
authors.initials: JC
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003287:Contrast Media; D003422:Critical Care / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D018450:Disease Progression; D042241:Early Diagnosis; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016019:Survival Analysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media