Dual-Energy CT in Hemorrhagic Progression of Cerebral Contusion: Overestimation of Hematoma Volumes on Standard 120-kV Images and Rectification with Virtual High-Energy Monochromatic Images After Contrast-Enhanced Whole-Body Imaging

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2018 Feb 14

PMID 29439124

Citations 6

Authors

U K Bodanapally

K Shanmuganathan

G Issa

D Dreizin

G Li

K Sudini

T R Fleiter

Affiliations

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Abstract

Background And Purpose: In patients with hemorrhagic contusions, hematoma volumes are overestimated on follow-up standard 120-kV images obtained after contrast-enhanced whole-body CT. We aimed to retrospectively determine hemorrhagic progression of contusion rates on 120-kV and 190-keV images derived from dual-energy CT and the magnitude of hematoma volume overestimation.

Materials And Methods: We retrospectively analyzed admission and follow-up CT studies in 40 patients with hemorrhagic contusions. After annotating the contusions, we measured volumes from admission and follow-up 120-kV and 190-keV images using semiautomated 3D segmentation. Bland-Altman analysis was used for hematoma volume comparison.

Results: On 120-kV images, hemorrhagic progression of contusions was detected in 24 of the 40 patients, while only 17 patients had hemorrhagic progression of contusions on 190-keV images ( = .008). Hematoma volumes were systematically overestimated on follow-up 120-kV images (9.68 versus 8 mm; mean difference, 1.68 mm; standard error, 0.37; < .001) compared with 190-keV images. There was no significant difference in volumes between admission 120-kV and 190-keV images. Mean and median percentages of overestimation were 29% (95% CI, 18-39) and 22% (quartile 3 - quartile 1 = 36.8), respectively.

Conclusions: The 120-kV images, which are comparable with single-energy CT images, significantly overestimated the hematoma volumes, hence the rate of hemorrhagic progression of contusions, after contrast-enhanced whole-body CT. Hence, follow-up of hemorrhagic contusions should be performed on dual-energy CT, and 190-keV images should be used for the assessment of hematoma volumes.

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References

Miller J, BUTTERWORTH J, Gudeman S, Faulkner J, Choi S, Selhorst J . Further experience in the management of severe head injury. J Neurosurg. 1981; 54(3):289-99. DOI: 10.3171/jns.1981.54.3.0289. View

Stiell I, Clement C, Grimshaw J, Brison R, Rowe B, Lee J . A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. CMAJ. 2010; 182(14):1527-32. PMC: 2950184. DOI: 10.1503/cmaj.091974. View

Lobato R, Gomez P, Alday R, Rivas J, Dominguez J, Cabrera A . Sequential computerized tomography changes and related final outcome in severe head injury patients. Acta Neurochir (Wien). 1997; 139(5):385-91. DOI: 10.1007/BF01808871. View

Matsumoto K, Jinzaki M, Tanami Y, Ueno A, Yamada M, Kuribayashi S . Virtual monochromatic spectral imaging with fast kilovoltage switching: improved image quality as compared with that obtained with conventional 120-kVp CT. Radiology. 2011; 259(1):257-62. DOI: 10.1148/radiol.11100978. View

Lee T, Aldana P, Kirton O, Green B . Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate. Acta Neurochir (Wien). 1997; 139(11):1042-7; discussion 1047-8. DOI: 10.1007/BF01411558. View

Alahmadi H, Vachhrajani S, Cusimano M . The natural history of brain contusion: an analysis of radiological and clinical progression. J Neurosurg. 2009; 112(5):1139-45. DOI: 10.3171/2009.5.JNS081369. View

Wang M, Linnau K, Tirschwell D, Hollingworth W . Utility of repeat head computed tomography after blunt head trauma: a systematic review. J Trauma. 2006; 61(1):226-33. DOI: 10.1097/01.ta.0000197385.18452.89. View

Bodanapally U, Dreizin D, Issa G, Archer-Arroyo K, Sudini K, Fleiter T . Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images. AJNR Am J Neuroradiol. 2017; 38(10):1946-1952. PMC: 7963601. DOI: 10.3174/ajnr.A5318. View

Bodanapally U, Sours C, Zhuo J, Shanmuganathan K . Imaging of Traumatic Brain Injury. Radiol Clin North Am. 2015; 53(4):695-715, viii. DOI: 10.1016/j.rcl.2015.02.011. View

10.

Bodanapally U, Addis H, Dreizin D, Reddy A, Margo J, Archer-Arroyo K . Prognostic Predictors of Visual Outcome in Open Globe Injury: Emphasis on Facial CT Findings. AJNR Am J Neuroradiol. 2017; 38(5):1013-1018. PMC: 7960379. DOI: 10.3174/ajnr.A5107. View

11.

Gupta R, Phan C, Leidecker C, Brady T, Hirsch J, Nogueira R . Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology. 2010; 257(1):205-11. DOI: 10.1148/radiol.10091806. View

12.

Cepeda S, Gomez P, Castano-Leon A, Martinez-Perez R, Munarriz P, Lagares A . Traumatic Intracerebral Hemorrhage: Risk Factors Associated with Progression. J Neurotrauma. 2015; 32(16):1246-53. DOI: 10.1089/neu.2014.3808. View

13.

Potter C, Sodickson A . Dual-Energy CT in Emergency Neuroimaging: Added Value and Novel Applications. Radiographics. 2016; 36(7):2186-2198. DOI: 10.1148/rg.2016160069. View

14.

Postma A, Das M, Stadler A, Wildberger J . Dual-Energy CT: What the Neuroradiologist Should Know. Curr Radiol Rep. 2015; 3(5):16. PMC: 4363523. DOI: 10.1007/s40134-015-0097-9. View

15.

Yu L, Leng S, McCollough C . Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol. 2012; 199(5 Suppl):S9-S15. DOI: 10.2214/AJR.12.9121. View

16.

Patel A, Gerzanich V, Geng Z, Simard J . Glibenclamide reduces hippocampal injury and preserves rapid spatial learning in a model of traumatic brain injury. J Neuropathol Exp Neurol. 2010; 69(12):1177-90. DOI: 10.1097/NEN.0b013e3181fbf6d6. View

17.

Phan C, Yoo A, Hirsch J, Nogueira R, Gupta R . Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol. 2012; 33(6):1088-94. PMC: 8013231. DOI: 10.3174/ajnr.A2909. View

18.

Kurland D, Hong C, Aarabi B, Gerzanich V, Simard J . Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma. 2011; 29(1):19-31. PMC: 3253310. DOI: 10.1089/neu.2011.2122. View

19.

Huang A, Lee C, Hsieh H, Yang C, Tsai Y, Tsuang F . Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. J Trauma. 2011; 71(6):1593-9. DOI: 10.1097/TA.0b013e31822c8865. View

20.

Gunn M, Kool D, Lehnert B . Improving Outcomes in the Patient with Polytrauma: A Review of the Role of Whole-Body Computed Tomography. Radiol Clin North Am. 2015; 53(4):639-56, vii. DOI: 10.1016/j.rcl.2015.02.006. View