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<meta name="DC.Title" content="Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5318" />
<meta name="DC.Date" content="2017-10-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma.

MATERIALS AND METHODS: We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images.

RESULTS: Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60–78 years; P &lt; .001) and had a higher incidence of intracranial hemorrhage ( P = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81–1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%–100%) and the specificity was 91.67% (95% CI, 73%–99%).

CONCLUSIONS: Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies.

DECT
:   dual-energy CT
ESDE
:   enhancing subdural effusion
HU
:   Hounsfield unit
SDH
:   subdural hematoma
SECT
:   single-energy CT
VNC
:   virtual noncontrast" />
<meta name="DC.Contributor" content="U.K. Bodanapally" />
<meta name="DC.Contributor" content="D. Dreizin" />
<meta name="DC.Contributor" content="G. Issa" />
<meta name="DC.Contributor" content="K.L. Archer-Arroyo" />
<meta name="DC.Contributor" content="K. Sudini" />
<meta name="DC.Contributor" content="T.R. Fleiter" />
<meta name="article:published_time" content="2017-10-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60–78 years; &lt;i&gt;P&lt;/i&gt; &amp;lt; .001) and had a higher incidence of intracranial hemorrhage (&lt;i&gt;P&lt;/i&gt; = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81–1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%–100%) and the specificity was 91.67% (95% CI, 73%–99%).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies.&lt;/p&gt;" />
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<meta name="citation_author_institution" content="aFrom the Department of Diagnostic Radiology and Nuclear Medicine (U.K.B., D.D., G.I., K.L.A.-A., T.R.F.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland" />
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<meta name="citation_author_institution" content="aFrom the Department of Diagnostic Radiology and Nuclear Medicine (U.K.B., D.D., G.I., K.L.A.-A., T.R.F.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland" />
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<meta name="twitter:title" content="Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma.

MATERIALS AND METHODS: We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images.

RESULTS: Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60–78 years; P &lt; .001) and had a higher incidence of intracranial hemorrhage ( P = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81–1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%–100%) and the specificity was 91.67% (95% CI, 73%–99%).

CONCLUSIONS: Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies.

DECT
:   dual-energy CT
ESDE
:   enhancing subdural effusion
HU
:   Hounsfield unit
SDH
:   subdural hematoma
SECT
:   single-energy CT
VNC
:   virtual noncontrast" />
<meta name="og-title" property="og:title" content="Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/10/1946" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma.

MATERIALS AND METHODS: We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images.

RESULTS: Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60–78 years; P &lt; .001) and had a higher incidence of intracranial hemorrhage ( P = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81–1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%–100%) and the specificity was 91.67% (95% CI, 73%–99%).

CONCLUSIONS: Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies.

DECT
:   dual-energy CT
ESDE
:   enhancing subdural effusion
HU
:   Hounsfield unit
SDH
:   subdural hematoma
SECT
:   single-energy CT
VNC
:   virtual noncontrast" />
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      <h1 class="highwire-cite-title" id="page-title">Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">U.K. Bodanapally</span>, <span class="highwire-citation-author" data-delta="1">D. Dreizin</span>, <span class="highwire-citation-author" data-delta="2">G. Issa</span>, <span class="highwire-citation-author" data-delta="3">K.L. Archer-Arroyo</span>, <span class="highwire-citation-author" data-delta="4">K. Sudini</span> and <span class="highwire-citation-author" data-delta="5">T.R. Fleiter</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1946-1952; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5318 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-56245--61432114840" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">U.K. Bodanapally </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic Radiology and Nuclear Medicine (U.K.B., D.D., G.I., K.L.A.-A., T.R.F.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=U.K.%2BBodanapally%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bodanapally%20U&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AU.K.%2BBodanapally%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0455-816X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for U.K. Bodanapally</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D. 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      <div class="highwire-cite-title">Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">U.K.</span> <span class="nlm-surname">Bodanapally</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Dreizin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Issa</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">K.L.</span> <span class="nlm-surname">Archer-Arroyo</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Sudini</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">T.R.</span> <span class="nlm-surname">Fleiter</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1946-1952; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5318 </span></div>
  
  
  
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      <div class="highwire-cite-title">Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">U.K.</span> <span class="nlm-surname">Bodanapally</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Dreizin</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Issa</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">K.L.</span> <span class="nlm-surname">Archer-Arroyo</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Sudini</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">T.R.</span> <span class="nlm-surname">Fleiter</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(10) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1946-1952; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5318 </span></div>
  
  
  
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