title: Contrast extravasation on CT angiography predicts hematoma expansion and mortality in acute traumatic subdural hemorrhage.
abstract: OBJECTIVE
  The presence of active contrast extravasation at CTA predicts hematoma expansion and in-hospital mortality in patients with nontraumatic intracerebral hemorrhage. This study aims to determine the frequency and predictive value of the contrast extravasation in patients with aSDH.
  
  
  METHODS
  We retrospectively reviewed 157 consecutive patients who presented to our emergency department over a 9-year period with aSDH and underwent CTA at admission and a follow-up NCCT within 48 hours. Two experienced readers, blinded to clinical data, reviewed the CTAs to assess for the presence of contrast extravasation. Medical records were reviewed for baseline clinical characteristics and in-hospital mortality. aSDH maximum width in the axial plane was measured on both baseline and follow-up NCCTs, with hematoma expansion defined as >20% increase from baseline.
  
  
  RESULTS
  Active contrast extravasation was identified in 30 of 199 discrete aSDHs (15.1%), with excellent interobserver agreement (κ = 0.80; 95% CI, 0.7-0.9). The presence of contrast extravasation indicated a significantly increased risk of hematoma expansion (odds ratio, 4.5; 95% CI, 2.0-10.1; P = .0001) and in-hospital mortality (odds ratio, 7.6; 95% CI, 2.6-22.3; P = 0.0004). In a multivariate analysis controlled for standard risk factors, the presence of contrast extravasation was an independent predictor of aSDH expansion (P = .001) and in-hospital mortality (P = .0003).
  
  
  CONCLUSIONS
  Contrast extravasation stratifies patients with aSDH into those at high risk and those at low risk of hematoma expansion and in-hospital mortality. This distinction could affect patient treatment, clinical trial selection, and possible surgical intervention.
authors: Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors: J M
authors: JM
authors: Romero
authors: H R
authors: HR
authors: Kelly
authors: J E
authors: JE
authors: Delgado Almandoz
authors: J
authors: J
authors: Hernandez-Siman
authors: J C
authors: JC
authors: Passanese
authors: M H
authors: MH
authors: Lev
authors: R G
authors: RG
authors: González
mesh_terms: D000208:Acute Disease; D001900:Boston; D015984:Causality; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D015897:Comorbidity; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media