The Usefulness of Contrast Extravasation on CT Angiography in Spontaneous Intracerebral Hemorrhage

Keum, Han Joong; Whang, Kum; Hu, Chul; Kim, Hun Joo; Hong, Soon Ki; Pyen, Jhin Soo; Jung, Hyun Ho

Abstract

OBJECTIVE
The authors investigated the clinical and radiographic characteristics of patients who exhibited contrast extravasation on initial computed tomographic angiography (CTA) and assessed the its association with hematoma expansion.
METHODS
Ninety six patients who were diagnosed with intracerebral hemorrhage and who received CTA within 12 hours from initial onset of symptoms and who received a follow up brain CT within 48 hours from the initial CTA between April 2004 and March 2007 were retrospectively assessed. Contrast extravasation was defined as the presence of high-density material within the hematoma. Patients were classified into the extravasation and no extravasation groups. Clinical and radiographic variables were compared between the two groups.
RESULTS
Fifteen patients (19%) demonstrated presence of extravasation on initial CTA. A significantly higher rate of hematoma expansion was seen in the extravasation group compared to the non extravasation group (47% vs 17%, p=0.027). Mean time from onset of symptoms to initial CTA was significantly shorter in the extravasation group (3.5+/-1.3 hours vs 7.6+/-2.5 hours, p<0.001). Also, detection of extravasation on CTA significantly correlated with time from symptom onset to intial CTA, especially when it was less than 4 hours (p>0.001).
CONCLUSIONS
Earlier detection of extravasation using CTA may help in identifying possibly life threatening complications caused by hematoma expansion. However, a larger prospective cohort is warranted to validate this result.