Elsevier

Surgical Neurology

Volume 53, Issue 4, April 2000, Pages 303-311
Surgical Neurology

Trauma
Delayed magnetic resonance imaging with Gd-DTPA differentiates subdural hygroma and subdural effusion

https://doi.org/10.1016/S0090-3019(00)00199-3Get rights and content

Abstract

BACKGROUND

Posttraumatic subdural fluid collection is not a single clinical entity but can be divided into subdural hygroma and subdural effusion. Appropriate treatment requires preoperative differentiation. Delayed magnetic resonance (MR) imaging with intravenous administration of gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) was used to differentiate subdural hygroma and subdural effusion.

METHODS

Timed arterial blood specimens were taken after intravenous Gd administration in patients with posttraumatic subdural fluid collections (five subdural hygromas and 13 subdural effusions). Delayed MR imaging was performed 1 hour after administration of Gd-DTPA. Gd-DTPA concentrations in the subdural fluid and blood specimens were measured by ion coupled plasma emission spectrometry. Dynamic biologic modeling was used to calculate the transfer rate constant for Gd-DTPA influx into these subdural fluid collections.

RESULTS

The Gd concentrations in subdural hygromas and subdural effusions were 16 ± 6 and 79 ± 12 nmol/mL, respectively. The transfer rate constants for subdural hygromas and subdural effusions were 4.8 ± 2.1 and 20.6 ± 2.1 (×10−4)min−1, respectively. These values were significantly higher in subdural effusions than in subdural hygromas (p < 0.01). Delayed MR imaging with Gd showed significantly higher mean enhancement of 77.1 ± 14.2% for subdural effusions compared to 4.6 ± 3.1% for subdural hygromas (p < 0.01).

CONCLUSIONS

Delayed MR imaging with Gd can differentiate subdural hygroma and subdural effusion.

Section snippets

Materials and methods

This study included 15 patients (six men and nine women) aged between 50 and 87 years. Diagnoses were confirmed by CT findings of low density areas and T1-weighted MR imaging findings of low signal intensity areas. All patients had definite histories of head injury or craniotomy. Informed consent was obtained from each patient. This study was approved by our institution’s Scientific Review Board. Three patients had unilateral subdural hygroma and one had bilateral subdural hygromas. Nine

Results

Table 1 summarizes the clinical, CT, and CT cisternography findings in patients with posttraumatic subdural hygromas and subdural effusions. The mean volumes of the subdural hygromas and subdural effusions were 51 ± 14 mL and 59 ± 8 mL, respectively, without significant difference. The mean Hounsfield number of subdural hygromas was 16.1 ± 1.2, significantly lower than that of subdural effusions at 23.1 ± 2.7 (p < 0.05). CT cisternography showed contrast medium in the subdural fluid of all

Discussion

This study found that the Hounsfield number and signal intensity on T1-weighted MR imaging of subdural effusions were significantly higher than those of subdural hygromas. Subdural effusions usually contain xanthochromic fluid, and the protein content is higher than that of the CSF in subdural hygromas [6]. However, the differences in CT number and MR imaging signal intensity are not specific enough to differentiate these two conditions. The key points to differentiate these two clinical

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