Pseudoprogression of Intra-Axial Traumatic Hemorrhagic Brain Injury on CT following Prior Contrast Enhanced Exam
2Department of Neurology, Rambam Health Care Campus, Israel
3Faculty of Medicine, Technion- Israel institute of Technology, Israel
Background and Purpose: Traumatic brain injury is common in multi-trauma patients. After head NCCT such patients often undergo contrast-enhanced studies as part of total body CT protocols or for the evaluation of blood vessels. Because traces of this iodinated contrast material can be visible on follow-up head NCCTs, we investigated the effect of the residual contrast on the apparent size of traumatic intra-axial hematoma compared with the baseline NCCT.
Materials and Methods: 184 patients with 263 traumatic intra-axial brain hematomas included in this retrospective study. A control group of 87 patients with 117 brains hematomas had only NCCTs. The experimental group of 97 patients with 146 brain hematomas had contrast-enhanced studies shortly after the 1st head NCCTs. Volumetric measurements were performed for each lesion using manual segmentation method.
Results: There was a significant increase in the apparent volume between the 1st and the 2nd NCCT in the experimental group. No significant change was seen in the control group. Using regression models to adjust for any confounding demographic or clinical characteristics between the two groups, the only variable that was responsible for this effect was the administration of iodinated intravenous contrast material.
Conclusion: Recent iodinated contrast administration can significantly influence intra-axial hematoma volume on follow up NCCTs in trauma patients.