Purpose: In head trauma, neck/head CTA are indicated when there is concern for occult vascular injury. Prior studies showed that contrast extravasation (CE) on CTA might have prognostic and treatment implications, however data is scarce and opposing. In this study we sought to retrospectively characterize the implication of acute contrast extravasation on clinical outcome and care in a large patient`s cohort.
Methods and Materials: 244 cases were identified that matched the following search criteria: (a) acute trauma victims, (b) NCCT at presentation and early follow up CT up to 48 hrs, (c) CTA presentation (d) intracranial traumatic findings. CE was defined as intra-hematoma pooling of contrast, not within a blood vessel with density greater than 120 HU and of any shape or size. The reviewers were blinded to the patient`s outcome. The outcome was graded using Glasgow Coma Outcome Score (GCOS), based on the patient`s electronic record on discharge.
Results: 57 patients (23.3%) had CE on CTA upon hospital arrival. Hematoma types associated with CE were epidural hematoma, subdural hematoma and cortical contusion. On univariate analysis, patients with CE were significantly more likely to be intubated on arrival, had lower GCS on arrival, showed higher rates of hematoma growth, had active bleed intraoperatively, had longer hospitalization stay and had significantly higher rate of GCOS 1 (death). Patients without CE were significantly more likely to be treated conservatively and had higher rates of GCOS 5 (no or minimal neurologic injury). Per-hematoma type analysis showed that in patients with subdural hematoma and CE the prognostic effect of CE was retained and they were significantly more likely to have GCOS 1 (p=0.006). In patients with epidural hematoma and cortical contusion this association was not shown.
Multivariate analysis of outcome at discharge showed that the presence of any type of extravasation reduces the chance of a good outcome (p=0.02, OR=0.389, 95% CI=0.1760.862).
Conclusion: CE on CTA in acute head trauma setting is an important imaging finding that might have a prognostic significance. The prognostic effect is mostly apparent in patients with subdural hematoma.
