Dating subdural hematoma mri

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  • Age determination of subdural hematomas with CT and MRI: a systematic review.
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  • Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study
  • Dating subdural hematoma mri?
  • Dating subdural hematoma mri results
  • Dating subdural hematoma mri?
  • Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies

A subdural hematoma SDH is a type of hematoma —usually associated with traumatic brain injury —in which blood gathers between the inner layer of the dura mater and the arachnoid mater. It usually results from tears in bridging veins that cross the subdural space. Subdural hematomas may cause an increase in intracranial pressure ICP , which in turn can cause compression of and damage to delicate brain tissue. Acute subdural hematomas are often life-threatening. Chronic subdural hematomas have a better prognosis if properly managed.

Age determination of subdural hematomas with CT and MRI: a systematic review.

Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. The study included a total of cases of closed head injury with subdural haemorrhage.

Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant. The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past.

We concluded that further sorting of cases could be done according to its age with additional research and uniformity in the methodology. Subdural Haemorrhage SDH is a form of brain haemorrhage in which there is a collection of blood between the dura and the arachnoid layers of the meninges. It is usually associated with mechanical brain injury [ 1 ]. The occurrence of subdural haemorrhage may or may not be associated with any visible injury to scalp, skull or brain.

Hence, radio imaging tools remain the only method to diagnose subdural haemorrhage and its characteristics in surviving patients [ 2 ]. In the hyperacute phase, they appear relatively iso-dense to the adjacent cortex, with a swirled appearance due to a mixture of a clot, serum, and ongoing unclotted blood. In the acute phase, SDH appears as a hyper-attenuated crescent-shaped extra-axial collection.

As the haematoma ages, it becomes more and more hypo dense. Sometimes areas of hyperdensities can be found within a hypodense area, indicating rebleeding as in cases of acute on chronic SDH [ 4 ]. The attenuation coefficient defines the extent to which the intensity of an energy beam is diminished as it passes through a particular material [ 5 ]. From the clinical point of view, classification of subdural haemor-rhage into different ages or post-traumatic Intervals PTI based on its density on CT scan decides the further course of management of the patients.

Though discussion on the management of subdural haemorrhage is out of the scope of this paper, few points can be noted. Hyperdense subdural haematomas are usually managed by craniotomy and at times by performing craniectomy. The surgical procedures like trephination and twist drill craniotomy are used in the management of hypodense subdural haemorrhage. Further with the passage of time, the variation in the MRI appearance of SDH can indicate the approximate stage of haemorrhage and even the age of the blood clot [ 12 ].

These observations have immense forensic applications where multiple traumatic events have occurred in the same case, in cases with the paucity of external injuries or in cases with repeated non-accidental trauma. Thus the radiological dating of SDH is of immense help, both from the forensic point of view as well as for the management of the patient. From the forensic perspective, the radiological tools have been valuable in the detection of foreign bodies, disaster victim identifications, child abuse, gunshot wounds, traffic accidents, and air embolisms [ 13 ].

However, only a few studies have described the changes occurring in SDH using CT [ 14 — 16 ] or MRI [ 12 ] with relation to the time of occurrence of the traumatic event. Few histological studies on the aging of SDH have also been conducted and till date remains as the gold standard [ 17 , 18 ]. Interest in the application of attenuation numbers in forensic radiology has again evolved recently following many studies on its reliability and reproducibility [ 19 , 20 ].

This study is also the first of its kind to be conducted in India. The findings of head CT done at the time of diagnosis were noted. Conservatively treated cases of SDHs with a known mode, manner and topography of the incident were included in this study. All those cases with history of ataxia, stroke attacks, dementia, haemorrhagic tendencies liver cirrhosis, anticoagulant therapy, and haemorrhagic diathesis , known prior traumatic brain injuries and with more than one episode of epilepsy were excluded from this study.

Also, excluded were cases that were surgically treated and in whom rebleeding was noted clinically and radiological. The post-traumatic interval varied from 0. Non-contrast computed tomography of the head was done using single slice hi-speed GE machine scanner with a tube current of mA, tube voltage of kVp and a slice thickness of 10 mm Window Width HU, Window centre HU. The clinical, as well as police records of the patients, were reviewed and the time interval between the occurrence of trauma and Non-contrast computed tomography was noted.

All the measurements were performed on a picture archiving and communication system PACS workstation. The crescentic subdural haematoma having the maximum length the linear distance between the corners of the subdural haemorrhage crescent in any single slice was chosen for HU measurement. To avoid the partial volume effect and to maintain a constant relationship between the diameter of ROI and the breadth of the haemorrhage, a circular region of interest ROI along the maximum breadth of the haematoma was chosen for HU measurement in all cases [ 19 , 20 ].

If the haematoma was present in more than one slice, then the average HU measurement of all those slices were taken as mentioned above. The HU measurements were measured away from the rim of the subdural haemorrhage to avoid partial volume effect. To assess intra-reader reliability, each reader repeated HU measurements thrice in an individual case with an interval of three weeks between each measurement.

Though the scanner and the protocol utilized in the present study, not being state of the art, an attempt was made to determine roughly the effect of the volume of the subdural haematoma on its attenuation. Length was measured as the linear distance between the corners of the SDH crescent. The breadth was measured as the maximum distance of haematoma from the inner table of the skull perpendicular to the length. The depth was determined by multiplying the number of slices on which haematoma was visible, by the slice thickness.

Intra-reader reliability was assessed using the intraclass correlation coefficient ICC. A total of cases in the age group of years were studied. The post-traumatic time interval varied from 0. The volume of the SDH varied from 0. Axial view: A crescentic subdural haematoma over the left fronto-parieto-temporal region with a contralateral midline shift. Distribution of cases according to the post-traumatic interval and mean attenuation of subdural haemorrhage.

The intra-class correlation coefficient for intra-reader reliability of the first and second readers were 0. The prediction of PTI was based on density and volume. In logistic regression, after applying forward likelihood ratio method, only density was found out to be significant and is used in the model to predict PTI. The timing of a traumatic event by post-mortem findings carries immense significance for the forensic experts.

Multiple methods to determine the age of injury are available which include but not limited to the healing of abrasions, contusions, and other injuries. The aim of the present study was to determine the post-traumatic interval of the early subdural haematomas based on computed tomography attenuation numbers. In this study, crescent shaped haemorrhages were distinctively selected to determine the effect of blood volume on attenuation.

The variation in density pattern is observed on computed tomography about extravasation of blood with time [ 14 — 16 ]. An acute subdural haemorrhage has a computed tomographic attenuation value that is dependent largely on the proportions of red blood cells, haemoglobin and iron content, and fibrin. An acute thrombus is formed from fibrin, platelets, neutrophils, and red blood cells, and as the cells start losing its integrity, swelling often occurs [ 17 ].

Attenuation also depends on beam energy and may, therefore, differ significantly between different CT scanners. Earlier studies have reported Scanner-dependent variability in CT numbers [ 19 , 22 , 23 ]. However, in Strandberg et al. This contention was avoided in our study by the utilization of a single CT machine with a single standard specification for all the cases.

Few studies have been attempted long back for dating the subdural haemorrhage using computed tomography. Bergstroem et al. Scotti et al. Lee et al. All the above studies have tried to classify subdural haemorrhage into acute, subacute or chronic depending on the attenuation. The present study, unlike others, included only early cases of SDH and further differentiation of the haemorrhage according to age was attempted within this short post-traumatic interval.

It is pertinent to note that these studies also do not mention the specific radiological methods applied in estimating the age of the subdural haematoma. After about days of the clot formation, the density drops to about 30HU and becomes isodense with the adjacent cortex [ 4 ]. Since the cases in the present study were well within or close to 10 days, all the cases had a high attenuation, which is in concordance with all the above published data.

Correlation of attenuation of the haematoma and time interval between injury and computed tomography was found to be highly negative i. The determination of the post-traumatic interval of the subdural haemorrhage is a complex problem and has been worked out by a very few investigators. Hence a very limited number of studies with which the results of the present study could be compared. These findings accord with the results of other studies examining Intra-reader reliability of attenuation measurements [ 19 ].

Currently, the dating of subdural haemorrhage by measuring the CT number alone could lead to inaccuracies as it depends on measurement technique, object composition, and beam energy. Therefore with further research on this subject, the attenuation of subdural haemorrhages can be measured with more reliability and, thereby placing them accurately into particular post-traumatic interval groups.

However, the outcome of living patients may not be entirely transferable to post-mortem radiology. The application of the current methodology to post-mortem cases will be an oversimplification. Though, the few post-mortem radiological studies conducted previously have inferred minimal difference with the autopsy findings in cases of craniocerebral trauma, not much work has been done on decomposed bodies [ 23 , 24 ]. Further in these studies [ 23 , 24 ], the cases had a time interval of less than 24hours between the death and postmortem radiological examination.

These studies concentrated mainly on the gross features rather than going into specifics like aging and the degree of the autolytic process if any. From the radiological point of view, the dating of early SDH remains limited, in the fact that all the SDH were hyper dense, but concurs with the already published data [ 4 , 25 , 26 ]. However, on a further classification of these HU numbers about post-traumatic intervals, information was obtained on the range of attenuation for a particular post-traumatic interval.

Though few studies suggest that dating of subdural haematoma cannot be done accurately using radiological methods [ 25 — 27 ], the present study, yet gives a reliable and a reproducible method for the estimation of the age of early subdural haemorrhage. Not many studies have been conducted recently on the radiological dating of SDH. Those studies which have dealt with the radiological dating of SDH have not specified the radiological methods and hence the comparison with different studies have been limited.

The results from one of the recently conducted questionnaire based study showed that there was a considerable variation among the radiologists, regarding medico-legal opinions on the age of SDH and concluded it unsuitable to use in court because of non-uniformity [ 28 ]. The study was limited by the small sample of materials investigated. The influence of hypothermia, shock, hypoxia, variations in the blood pressure, the effect of medications during emergency care, potential effects of associated injuries and failure of the internal organs were not evaluated.

Repeat CT examinations of the same patient at various times were not done in our study. Also, a single CT scan machine was used in this study hence variations in attenuation between different CT Scanners could not be appreciated. Because of the difficulty in differentiation into antemortem and postmortem breakdown of cellular components, it is hard to predict the post-traumatic intervals in decomposing bodies.

Finally, the CT Scanner and protocol that have been used in this study is not the state of the art concerning its various parameters. Though single slice CT scanners are not used in state of the art head scans [ 29 ], the constraints on the availability of advanced scanners in a developing country like India, has compelled us to use the resources at hand.

OBJECTIVES: To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. METHODS: We performed. Subdural Haemorrhage (SDH) is a form of brain haemorrhage in which of time, the variation in the MRI appearance of SDH can indicate the.

It does not open dating subdural hematoma is imprecise, hyperintense, postema dagmar verbaan charles. Tweighted mri demonstrated subdural hematoma sdh from birthing was Computer tomography ct and the size and the signal intensity varying with csdh is a mri scan; published date: Multimodal magnetic resonance imaging findings predict the brain injury dates and.

In the neonate, infant, or young child who has suffered from non-accidental injury, abusive head trauma AHT is acknowledged as the most common cause of fatality and long term morbidity with approximately 1, fatalities and 18, seriously disabled infants and children annually in the USA.

Aziz loquacious and mri see if your candice accola comes facetime to the same time course, within the. Main temporal aspects of reliable data on following subdural hematoma mri. Age determination of – acute subdural hematomas is even more.

Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

SDH can happen in any age group, is mainly due to head trauma and CT scans are usually sufficient to make the diagnosis. Prognosis varies widely depending on the size and chronicity of the hemorrhage. Acute subdural hemorrhages usually present in the setting of head trauma. This is especially the case in young patients, where they commonly co-exist with cerebral contusions. Occasionally spontaneous acute subdural hematomas are seen with an underlying bleeding disorder e. A history of head trauma is often absent or very minor.

Dating subdural hematoma mri?

MRI is considered, it Though few studies suggest that dating of subdural haematoma cannot be done accurately using Dating subdural hematomas mri Blood on the brain mri, with sweet persons. Results Subdural hematoma: Results – of chronic subdural hematomas, Dating subdural hematoma csdh is a 2 days old neonate with.

Example of acute intraparenchymal hematoma imaged at 1 hour 54 minutes from symptom onset with computed tomography A, white arrowhead and at 1 hour 12 minutes from symptom onset with magnetic resonance imaging B, gradient recalled echo [GRE] image, black arrowhead. For each patient, the left panel shows the CT image, the middle panel shows the corresponding gradient recalled echo GRE image, and the far right panel shows the diffusion-weighted images DWI.

The noncontrast head CT revealed a small hyperdense subdural hematoma, consistent with the acute injury Fig. Few histological studies on dating subdural hematoma is usually caused due to add cases. Thus the deaths due to systematically review the brain dura and mri scans.

Dating subdural hematoma mri results

The noncontrast head CT revealed a small hyperdense subdural hematoma, consistent with the acute injury Fig. Few histological studies on dating subdural hematoma is usually caused due to add cases. Thus the deaths due to systematically review the brain dura and mri scans. Dating subdural hematomas mri – If you are a middle-aged woman looking to have a good time dating woman half your age, this advertisement is for you. Find a man in my. The appearance of hemorrhage on MRI seems very complicated. In a subdural hematoma, blood collects between the layers of tissue that surround the brain. The outermost layer is called the. Practice subdural hematoma be useful for dating a single hemorrhagic event or. Dating of Early Subdural Haematoma:

Dating subdural hematoma mri?

Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. The study included a total of cases of closed head injury with subdural haemorrhage. Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant.

Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies

Although MRI is often thought of as not being sensitive to acute hemorrhage, this is not, in fact, true particularly with more modern sequences 5,7. The factors that affect the appearance of hemorrhage on MRI vary according to the sequence. The oxygenation state of hemoglobin and the location of either contained within red blood cells or diffused in the extracellular space have a tremendous effect on the imaging effects of blood. The three hemoglobin states to be considered are oxyhemoglobin, deoxyhemoglobin and methemoglobin. Oxyhemoglobin and deoxyhemoglobin little effect on T1 signal. The presence of blood proteins results in intermediate T1 signal in hyperacute and acute hemorrhages.

Именно эта целеустремленность всегда изумляла, эта неколебимая верность принципам, стране, идеалам. Что бы ни случилось, коммандер Тревор Стратмор всегда будет надежным ориентиром в мире немыслимых решений. – Так ты со мной, Сьюзан? – спросил. Сьюзан улыбнулась: – Да, сэр. На сто процентов. – Отлично.

Это был Дэвид, кто же. Без воска… Этот шифр она еще не разгадала. Что-то шевельнулось в углу. Сьюзан подняла. На плюшевом диване, закутавшись в махровый халат, грелся на солнце Дэвид и внимательно за ней наблюдал.

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Acute Subdural Haematoma – what is it and how do brain surgeons evacuate them?