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. 2024 Feb 20;11(1):e931.
doi: 10.1002/ams2.931. eCollection 2024 Jan-Dec.

Relationship between extravascular leakage and clinical outcome on computed tomography of isolated traumatic brain injury

Hiroshi Ito  1 , Youhei Nakamura  1 , Yuki Togami  1 , Shinya Onishi  1 , Shunichiro Nakao  1 , Hiroshi Ogura  1 , Jun Oda  1
Affiliations

Relationship between extravascular leakage and clinical outcome on computed tomography of isolated traumatic brain injury

Hiroshi Ito et al. Acute Med Surg. .

Abstract

Aim: This study investigated whether contrast extravasation on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with death or surgical procedures.

Methods: Patients over 18 years old, directly brought in by ambulance with an isolated head injury and confirmed to have acute intracranial hemorrhage on a CT scan upon admission between 2010 and 2020, were included. The primary outcome was mortality, and the secondary outcome was neurosurgical procedures performed from admission to discharge from the intensive care unit. Multivariable logistic regression analyses were performed to evaluate the association between these outcomes and contrast extravasation.

Results: The analysis included 188 patients with a median age of 65 years, 123 men (65.4%), 34 deaths (18.1%), and 91 surgeries (48.4%). Among the 66 patients with contrast extravasation, 22 (33.3%) died and 47 (71.2%) required surgery. Among the 122 patients with no contrast extravasation, 12 (9.8%) died, and 44 (36.1%) required surgery. The presence or absence of extravascular leakage was associated with death (odds ratio, 3.6 [95% CI: 1.2-12.2]) and surgery (odds ratio, 7.6 [95% CI: 2.5-22.7]).

Conclusion: Contrast extravasation was associated with mortality and performance of surgery in patients with an isolated head injury.

Keywords: contrast extravasation; head injury; mortality; surgery.

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Conflict of interest statement

Dr. Hiroshi Ogura and Dr. Oda Jun are the Editorial Board members of AMS Journal and the co‐authors of this article. Dr. Jun Oda is the Editor‐in‐Chief of the journal. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication. Peer review was handled independently by the AMS Journal editorial office and Dr. Yasuyuki Kuwagata as the Editor to minimize bias.

Figures

FIGURE 1
FIGURE 1
Example of contrast extravasation on CT angiography in a patient with traumatic brain injury. (A) Plain CT scan showed an acute subdural hematoma. (B) Imaging findings in the arterial phase of the contrast‐enhanced CT scan. The square in A is enlarged. Contrast extravasation was observed in the area of the red oval as indicated by the arrow. (C) Imaging findings in the venous phase of the contrast‐enhanced CT scan. Extravascular leakage of contrast agent was also observed in the area of the red oval as indicated by the arrow. CT, computed tomography.
FIGURE 2
FIGURE 2
Patient flowchart. Among 536 patients with an isolated head injury, 278 patients met the inclusion criteria, and 90 patients met the exclusion criteria. In total, 188 patients were included in the analysis. CT, computed tomography.
FIGURE 3
FIGURE 3
Surgical flow of patients with and without contrast extravasation. The CT images showed 66 patients with contrast extravasation and 122 patients with no contrast extravasation. Among them, 34 and 39 required emergency surgery, 32 and 83 patients underwent observation only, and 13 and 5 patients required surgery while under observation, respectively. CT, computed tomography.
See this image and copyright information in PMC

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