title: Contusion Contrast Extravasation Depicted on Multidetector Computed Tomography Angiography Predicts Growth and Mortality in Traumatic Brain Contusion.
abstract: Traumatic brain injury (TBI) is the main cause of death in trauma victims and causes high rates of disability and neurological sequelae. Approximately 38-65% of traumatic brain contusions (TBC) demonstrate hemorrhagic expansion on serial computed tomography (CT) scans. Thus far, however, no single variable can accurately predict the hemorrhage expansion of a TBC. Our purpose was to evaluate contrast extravasation (CE) as a predictor of expansion, mortality, and poor outcome in TBC in a Brazilian cohort. After Institutional Review Board approval, we used multidetector CT angiography (MDCTA) to study 121 consecutive patients (106 men, 87.6%) with ages varying from 10 to 85 years. Informed consent was obtained from all subjects. The clinical and imaging findings were correlated with the findings on the initial MDCTA using either the Fisher exact test or Student t test and a multivariate logistic regression model. Of the persons who presented CE in TBC, 21.8% died (in-hospital mortality), whereas in the absence of this sign, the mortality rate was 7.6% (p = 0.014). In addition, expansion of the hemorrhagic component of the TBC was detected in 61.1% of the CE-positive patients, whereas expansion was only observed in 10% of the CE-negative patients (p < 0.001). Poor outcome was observed in 24.2% of the patients in the CE-negative group, but in the presence of CE, 72.7% evolved with poor outcome (p < 0.001). The CE was a strong independent predictor of expansion, poor outcome, and increased risk of in-hospital mortality in our series of patients with TBC.
authors.affiliation: 1 Section of Neuroradiology , Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil .|2 Section of Radiology, Federal University of Espírito Santo , Vitória ES, Brazil .
authors.forename: Marcos
authors.initials: M
authors.lastname: Rosa
authors.affiliation: 1 Section of Neuroradiology , Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil .
authors.forename: Antônio José
authors.initials: AJ
authors.lastname: da Rocha
authors.affiliation: 1 Section of Neuroradiology , Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil .
authors.forename: Antônio Carlos Martins
authors.initials: AC
authors.lastname: Maia
authors.affiliation: 3 Division of Neurosurgery , Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil .
authors.forename: Nelson
authors.initials: N
authors.lastname: Saade
authors.affiliation: 3 Division of Neurosurgery , Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil .
authors.forename: José Carlos Esteves
authors.initials: JC
authors.lastname: Veiga
authors.affiliation: 4 Division of Neuroradiology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts.
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070624:Brain Contusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D001938:Brazil / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D055815:Young Adult
keywords: contrast extravasation; multidetector CT angiography; spot sign; traumatic brain contusion; traumatic brain injury