Y. Takanashi et al., Magnetic resonance imaging with gadolinium DTPA enhancement in patients with acute head injury, J NEUROTRAU, 17(4), 2000, pp. 359-365
Gadolinium-enhanced magnetic resonance (MR) imaging in patients with acute
head injury was conducted to study if contrast extravasation was associated
with development of hemorrhagic lesions. A series of 60 head-injured patie
nts were admitted to our emergency unit. Computerized tomography (CT) scans
and skull x-ray films were taken as rapidly as possible after hospitalizat
ion. Injury severity on admission was evaluated using the Glasgow Coma Scal
e (GCS) score, motor score, and pupillary examination, while overall outcom
e was assessed with the Glasgow Outcome Scale (GOS) 3 months after injury.
Of all patients admitted, MR imaging with gadolinium enhancement was perfor
med in 18 patients who were at high risk of developing hemorrhagic lesion w
ithin 6 h after injury. In these patients we investigated whether contrast
extravasation was associated with development of hemorrhagic lesions. All 1
8 patients presented abnormal findings on their admission CT scans. Admissi
on GCS score in those patients who underwent MR imaging with gadolinium enh
ancement was 13 or more in 12 patients, 9-12 in four patients, and 8 or les
s in two patients. Fourteen of 18 patients showed contrast extravasation, c
orresponding with an evolution of lesion size. Nine of 14 patients who demo
nstrated extravasation of the contrast medium required surgical treatment.
The results of the current study suggest that extravasation of contrast med
ium indicates a continuance of posttraumatic bleeding. Thus, MR imaging wit
h gadolinium enhancement in acutely head-injured patients may constitute a
reasonable strategy for predicting the development of hemorrhagic lesions.