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Subdural Hematoma — What is the Role of Brain Scanning in its Diagnosis?

The Hospital for Sick Children, Toronto, Ontario

Correspondence: For reprints contact: David L. Gilday, Div. of Nuclear Medicine, the Hospital for Sick Children, 555 University Ave., Toronto 2, Ontario, Canada.

ABSTRACT

A comparison was made between brain scans and cerebral angiography in 40 patients with subdural hematomas confirmed by surgery. Lesion size was estimated as the difference in width and intensity of peripheral radioactivity between the two sides of brain scans and by maximum displacement of cerebral vessels from the skull on angiography. Scans were positive in 30 of 32 unilateral hematomas (all 12 acute and 18 of 20 chronic). The degree of scan abnormality correlated well with the x-ray findings. In 98 patients in whom the clinical course was reviewed, 87 had a prescan diagnosis of possible hematoma and 11 without clinical evidence had suspicious or positive scans. In the group surveyed, the false-negative rate was 4% and the false-positive rate was 11%, the latter usually with an obvious clinical or radiographic explanation. The likelihood of hematoma was very low in the "suspicious scan" category.

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