Contrast Extravasation on CT Angiography Predicts Hematoma Expansion and Mortality in Acute Traumatic Subdural Hemorrhage

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig 1.
Relationship between the presence of contrast extravasation and the percentage of aSDH that demonstrated expansion shows a larger proportion of expanding aSDH in the group with contrast extravasation.
Download figure
Open in new tab
Download powerpoint
Fig 2.
CT images of a 75-year-old man with blunt craniocervical trauma related to a motor vehicle crash. A, Axial source image from the CTA of the head in the emergency department demonstrates contrast extravasation (arrow) in the right hemispheric aSDH. B, Follow-up axial NCCT of the head at approximately the same level (obtained 4 hours later) demonstrates an increase of >20% of the aSDH thickness (arrow).
Download figure
Open in new tab
Download powerpoint
Fig 3.
CT images of an 86-year-old man, status post fall. A, Axial image from the NCCT on admission demonstrates a left hemispheric aSDH and adjacent subarachnoid hemorrhage. B, C, and D, Images from the CTA acquired in the emergency department immediately after the NCCT demonstrate multiple foci of contrast extravasation (arrows) at various levels in the left frontal component of the aSDH. These foci of contrast extravasation were not contiguous with cortical vessels on review of the entire imaging study. The family declined further medical or surgical intervention, and the patient died in the emergency department shortly after the CTA was performed.

Table 1:

Baseline clinical and radiologic characteristics

Characteristic
Mean age, years (SD)	52 (22.5)
Sex
Male (%)	117 (75)
Female (%)	40 (25)
Mean admission blood pressure, mm Hg
Systolic (SD)	140.7 (26.8)
Diastolic (SD)	76.4 (14.8)
Mean admission GCS (SD)	11.58 (4.17)
History of hypertension (%)	46 (29)
Mean admission platelet count (SD)	244 (71)
Mean admission INR (SD)	1.24 (0.53)
Mean admission aPTT (SD)	25.70 (5.33)
Altered coagulation (%)	9 (6)
Antiplatelet therapy (%)	24 (15)
Mechanism of injury
Fall from standing (%)	84 (54)
Fall from height (%)	18 (12)
Motor vehicle crash (%)	24 (15)
Pedestrian struck (%)	16 (10)
Direct blunt trauma (%)	13 (8)
Penetrating trauma (%)	2 (1)
aSDH location
Frontal (%)	99 (50)
Temporal (%)	38 (19)
Parietal (%)	31 (16)
Parafalcine (%)	15 (8)
Occipital (%)	13 (6)
Cerebellar (%)	3 (1)
Mean initial maximum aSDH width, mm (SD)	6.0 (3.5)
Mean initial maximum midline shift, mm (SD)	2.2 (2.9)
Mean time to follow-up NCCT, hours (SD)	11.76 (7.98)

Table 2:

Comparison of baseline characteristics between patients with and without spot sign

Characteristic	Spot Sign (n = 27)	No Spot Sign (n = 130)	P Value
Mean age, years (SD)	59 (22.2)	50 (22.4)	.07^{^a}
Sex (%)			.22^{^b+}
Male	23 (85)	94 (72)
Female	4 (15)	36 (28)
Admission blood pressure, mm Hg
Systolic (SD)	144.4 (30.5)	140.0 (26.1)	.50^{^a}
Diastolic (SD)	76.7 (15.9)	76.4 (14.7)	.93^{^a}
Mean admission GCS (SD)	10.2 (4.3)	11.8 (4.1)	.09^{^c}
History of hypertension (%)	13 (48)	33 (25)	.02^{^b}
Mean admission platelet count (SD)	235.4 (85.5)	246.2 (68.2)	.47^{^a}
Mean admission INR (SD)	1.3 (0.8)	1.2 (0.5)	.27^{^a}
Mean admission aPTT (SD)	27.4 (6.3)	25.4 (5.1)	.08^{^a}
Altered coagulation (%)	2 (7)	7 (5)	.48^{^b}
Antiplatelet therapy (%)	6 (22)	18 (14)	.38^{^b}
Mean initial maximum aSDH width, mm (SD)	6.9 (3.6)	5.8 (3.5)	.12^{^a}
Mean initial maximum midline shift, mm (SD)	0.40 (0.4)	0.18 (0.3)	.0004^{^a}
Mean time to follow-up NCCT, hours (SD)	9.58 (7)	11.28 (7.3)	.29^{^a}

Table 3:

Accuracy of the contrast extravasation (spot sign) for the prediction of hematoma expansion and in-hospital mortality in patients with aSDH

Note:—LR indicates likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.
↵a Defined as an increase ≥20% from the initial maximum axial aSDH width.

Table 4:

Comparison of clinical and radiologic characteristics between surviving and nonsurviving patients with aSDH

Characteristic	Survived (n = 140)	Died (n = 17)	P Value
Mean age, years (SD)	51 (22.4)	59 (23.2)	.16^{^a}
Sex (%)			.56^{^b}
Male	103 (74)	14 (82)
Female	37 (26)	3 (18)
Mean admission blood pressure, mm Hg
Systolic (SD)	139.9 (26.5)	147 (29.5)	.37^{^a}
Diastolic (SD)	76.3 (14.9)	78.2 (14.7)	.66^{^a}
Mean admission GCS (SD)	12 (3.9)	8 (4.8)	.0003^{^c}
History of hypertension (%)	38 (27)	8 (47)	.10^{^b}
Mean admission platelet count (SD)	247.4 (70.4)	219.7 (76.2)	.13^{^a}
Mean admission INR (SD)	1.2 (0.45)	1.6 (1.0)	.015^{^a}
Mean admission aPTT (SD)	25.4 (5.1)	28.5 (6.7)	.022^{^a}
Altered coagulation (%)	7 (5)	2 (12)	.25^{^b}
Antiplatelet therapy (%)	19 (14)	5 (30)	.14^{^b}
Mean initial maximum aSDH width, mm (SD)	6 (3.6)	6 (3)	.99^{^a}
Mean initial maximum midline shift, mm (SD)	2 (2.6)	3.9 (4.2)	.011^{^a}
Patients with contrast extravasation (%)	18 (13)	9 (53)	.0004^{^b}
Patients without contrast extravasation (%)	122 (87)	8 (47)	.0004^{^b}
Mean time to follow-up NCCT, hours (SD)	12 (8.2)	9.7 (5.5)	.27^{^a}