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Dual-energy CT imaging of chronic subdural hematoma membranes: technical note

  • Computed Tomography
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Abstract

This technical note describes a novel dual-energy CT (DECT) protocol with iodine map reconstruction that will enable visualization of chronic subdural hematoma (CSDH) membranes. We describe the technique and discuss the potential implications for surgical management. The cohort included 36 patients with 50 hematomas. Enhancing external membrane was demonstrated in all the 50 hematomas, incomplete internal membrane in 13, and complete internal membrane in 23 hematomas. A spandrel sign at the transition zone that indicates partial or complete formation of internal membrane was demonstrated in 36 hematomas.

Key Points

• Iodine maps from 5-min delayed post-contrast DECT provide spectral contrast difference and facilitate segregation of chronic subdural hematoma membranes.

• The ability to image the membranes helps in assessing the degree of organization of the hematoma by providing the information about the membrane thickness, volume, complexity of the membranes, and the proportion of the liquefied component within the hematoma before surgical procedures are undertaken.

• Membrane visualization helps in the localization of the transition zone and extension of the membranes over the cerebral lobes helping in the determination of craniotomy location and size, during membranectomy.

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Abbreviations

CSDH:

Chronic subdural hematoma

CTA:

CT angiography

DECT:

Dual-energy CT

MMAE:

Middle meningeal artery embolization

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Uttam K. Bodanapally, Thorsten R. Fleiter & Dheeraj Gandhi

  2. Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, USA

    Bizhan Aarabi

  3. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA

    Ajay Malhotra

Authors
  1. Uttam K. Bodanapally
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  2. Thorsten R. Fleiter
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  3. Bizhan Aarabi
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  4. Ajay Malhotra
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  5. Dheeraj Gandhi
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Corresponding author

Correspondence to Uttam K. Bodanapally.

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The scientific guarantor of this publication is Uttam K. Bodanapally.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Methodology

• retrospective

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• performed at one institution

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Supplementary Information

ESM 1

A 68-year-old man presented with left holohemispheric chronic subdural hematoma. (A) 5-minute delayed phase gray-scale iodine maps shows well defined external membrane (arrowheads). (B) Label masks of external membrane created on (3D) Slicer using 90 kV 5-minute delayed images. (DOCX 4507 kb)

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Bodanapally, U.K., Fleiter, T.R., Aarabi, B. et al. Dual-energy CT imaging of chronic subdural hematoma membranes: technical note. Eur Radiol 33, 797–802 (2023). https://doi.org/10.1007/s00330-022-09064-z

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  • DOI: https://doi.org/10.1007/s00330-022-09064-z

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