Computed Tomography: Contrast Media within Subdural Hematomas. A Preliminary Report 1 Albert V. Messina, M.D. Delayed computed tomographic scans may be most helpful in disclosing subdural hematomas which have collected contrast media when the lesion is undisclosed by initial or immediate post-contrast scans. INDEX TERMS:
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Vol. 119
Brain, hemorrhage. Computed tomography, cranial
Radiology 119:725-726, June 1976
Subdural hematomas may be quite difficult to demonstrate by computed tomography (CT), particularly if bilateral and relatively small (1, 2). This difficulty is particularly evident in the subacute lesion, the density of which may simulate adjacent normal brain tissue. With the use of intravenous contrast enhancement and delayed CT scanning, we have been able to show that contrast media entered subdural collections, which progressively increased in density and were maximally enhanced on delayed, post-contrast scans. Chemical determinations performed on the case illustrated in Figure 1 showed that the subdural iodine concentration was about 20 times greater than that of the circulating blood at 6 hr. after intrave-
Work In Progress
nous injection. In cases in which such lesions are strongly suspected but not well shown on CT, therefore, intravenous contrast enhancement and subsequent scans at 4-6 hr. or later may be quite helpful. Department of Radiology Section of Neuroradiology New York Hospital-Cornell University Medical Center New York, N. Y. 10021
REFERENCES 1. Ambrose J: Computerized transverse axial scanning (tomography): part 2. Clinical applications. Br J Radiol 46:1023-1047, Dec 1973 2. New PFJ, Scott WR, Schnur JA, et al: Computerized axial tomography with the EMI scanner. Radiology 110: 109-123, Jan
1974
1 From the Department of Radiology, Section of Neuroradiology, New York Hospital-Cornell University Medical Center, New York, ss N. Y. Accepted for publication in February, 1976.
(Figure 1 appears on the next page)-
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Fig. 1. Subdural hematoma, right. Right sided headaches developed in an eighty-one-year-old man one week atter minor head trauma. The neurological examination was unremarkable. The CT scan was performed three weeks after the injury. Columns 1 and 2, identical sections; 1: window level 22, window width 50; 2: window level 22, window width 1 m. Columns 3 and 4, identical slices 1.3 cm above columns 1 and 2; 3: window level 22, window width 50; 4: window level 22, window width 1 m. Top row: prior to contrast enhancement. Ventricular compression and leftward deviation are apparent (arrow). Superior portions of the subdural collection are less dense than brain (upper arrowhead). More dependent portions (lower arrowheads) are of tissue density and indistinguishable from contiguous brain tissue. Center row: Sections taken immediately after bolus injection of 120 cc Conray 60 (34 g iodine). Note the increased density of the compressed brain surface, including vascular structures and, perhaps, membranes (arrowheads). Note the slight increase in density of the subdura! collection itself, particularly the most dependent portion (arrow). Straight sinus: dense linear lower central structure. Bottom row: Sections taken 4 hours after contrast injection. There is a diffuse increase in the density of the subdural collection (unlabelled). Note the diminished intensity of the straight sinus density due to the much lower blood iodine concentration than immediately after injection. Also note the absence of sulci over the right convexity. Six hours after injection, simultaneous subdural fluid and blood specimens showed 60 mg/ 100 ml and 3 mg/1 00 ml iodine levels, respectively.
725
WORK IN PROGRESS
Vol. 119
Brain, hemorrhage. Computed tomography, cranial
Radiology 119:725-726, June 1976
Subdural hematomas may be quite difficult to demonstrate by computed tomography (CT), particularly if bilateral and relatively small (1, 2). This difficulty is particularly evident in the subacute lesion, the density of which may simulate adjacent normal brain tissue. With the use of intravenous contrast enhancement and delayed CT scanning, we have been able to show that contrast media entered subdural collections, which progressively increased in density and were maximally enhanced on delayed, post-contrast scans. Chemical determinations performed on the case illustrated in Figure 1 showed that the subdural iodine concentration was about 20 times greater than that of the circulating blood at 6 hr. after intrave-
Work In Progress
nous injection. In cases in which such lesions are strongly suspected but not well shown on CT, therefore, intravenous contrast enhancement and subsequent scans at 4-6 hr. or later may be quite helpful. Department of Radiology Section of Neuroradiology New York Hospital-Cornell University Medical Center New York, N. Y. 10021
REFERENCES 1. Ambrose J: Computerized transverse axial scanning (tomography): part 2. Clinical applications. Br J Radiol 46:1023-1047, Dec 1973 2. New PFJ, Scott WR, Schnur JA, et al: Computerized axial tomography with the EMI scanner. Radiology 110: 109-123, Jan
1974
1 From the Department of Radiology, Section of Neuroradiology, New York Hospital-Cornell University Medical Center, New York, ss N. Y. Accepted for publication in February, 1976.
(Figure 1 appears on the next page)-
726
WORK IN PROGRESS
June 1976
Fig. 1. Subdural hematoma, right. Right sided headaches developed in an eighty-one-year-old man one week atter minor head trauma. The neurological examination was unremarkable. The CT scan was performed three weeks after the injury. Columns 1 and 2, identical sections; 1: window level 22, window width 50; 2: window level 22, window width 1 m. Columns 3 and 4, identical slices 1.3 cm above columns 1 and 2; 3: window level 22, window width 50; 4: window level 22, window width 1 m. Top row: prior to contrast enhancement. Ventricular compression and leftward deviation are apparent (arrow). Superior portions of the subdural collection are less dense than brain (upper arrowhead). More dependent portions (lower arrowheads) are of tissue density and indistinguishable from contiguous brain tissue. Center row: Sections taken immediately after bolus injection of 120 cc Conray 60 (34 g iodine). Note the increased density of the compressed brain surface, including vascular structures and, perhaps, membranes (arrowheads). Note the slight increase in density of the subdura! collection itself, particularly the most dependent portion (arrow). Straight sinus: dense linear lower central structure. Bottom row: Sections taken 4 hours after contrast injection. There is a diffuse increase in the density of the subdural collection (unlabelled). Note the diminished intensity of the straight sinus density due to the much lower blood iodine concentration than immediately after injection. Also note the absence of sulci over the right convexity. Six hours after injection, simultaneous subdural fluid and blood specimens showed 60 mg/ 100 ml and 3 mg/1 00 ml iodine levels, respectively.
