Tomida M, Muraki M, Uemura K, Yamasaki K
Department of Neurosurgery, Shinshiro Municipal Hospital, Japan.
Neurosurgery. 1998 Jul;43(1):66-70; discussion 70-1. doi: 10.1097/00006123-199807000-00040.
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.
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.
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.
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.
我们研究了在急性期通过使用钆喷酸葡胺增强磁共振成像（MRI）来预测创伤性硬膜外血肿（EDH）和硬膜下血肿（SDH）进展的可能性。
从1990年1月至1996年12月，41例有43处血肿（21处EDH和22处SDH）的患者在受伤后24小时内接受了增强MRI检查。在计算机断层扫描后立即静脉注射0.1 mmol/kg钆喷酸葡胺，然后采用自旋回波法进行T1加权MRI检查。
所有增强的血肿均增大，而未增强的血肿，除了两处有出血倾向的SDH外，体积保持不变或减小。用这种方法预测血肿增大的准确率，EDH为100%（21/21），SDH为91.0%（20/22）。该检查预测血肿增大的敏感性，EDH为100%（15/15），SDH为81.8%（9/11）。两种血肿的特异性均为100%。弥漫性增强血肿的增大率在统计学上高于未增强血肿。所有术中发现有活动性出血点的弥漫性增强血肿患者均出现意识恶化。
我们得出结论，弥漫性增强表明存在持续出血的破裂血管渗漏，弥漫性增强的血肿会迅速增大。我们认为增强MRI对预测急性EDH和SDH的进展非常有用。
