Postcontrast magnetic resonance imaging to predict progression of traumatic epidural and subdural hematomas in the acute stage.

OBJECTIVE: We investigated the possibility of predicting the progression of traumatic epidural hematomas (EDHs) and subdural hematomas (SDHs), in the acute stage, by using postcontrast magnetic resonance imaging (MRI) with gadolinium-diethylenetriaminepentaacetic acid.

METHODS: From January 1990 through December 1996, 41 patients with 43 hematomas (21 EDHs and 22 SDHs) underwent postcontrast MRI within 24 hours after injury. T1-weighted MRI was performed by using the spin echo method, after the administration of 0.1 mmol/kg gadolinium-diethylenetriaminepentaacetic acid, immediately after computed tomographic scanning.

RESULTS: All of the enhanced hematomas were enlarged, whereas nonenhanced hematomas, except for two SDHs with bleeding tendencies, remained unchanged or decreased in volume. The prediction rates for enlargement with this method were 100% (21 of 21) for EDHs and 91.0% (20 of 22) for SDHs. The sensitivity of this test in predicting enlargement was 100% (15 of 15) for EDHs and 81.8% (9 of 11) for SDHs. The specificity was 100% for both types of hematomas. The enlargement rates for diffusely enhanced hematomas were statistically greater than those for nonenhanced hematomas. All of the patients with diffusely enhanced hematomas, which were found during surgery to exhibit active bleeding points, experienced consciousness deterioration.

CONCLUSION: We conclude that diffuse enhancement indicates extravasation from broken vessels that continue to bleed and that diffusely enhancing hematomas will be rapidly enlarged. We think that postcontrast MRI can be very useful for predicting the progression of acute EDHs and SDHs.