Acta Neurochirurgica

, Volume 139, Issue 6, pp 560–565 | Cite as

Connective tissue reactions in subdural haematomas: Imaging with contrast-enhancement MRI

  • J. Spreer
  • R. -I. Ernestus
  • H. Lanfermann
  • K. Lackner
Clinical Articles


The sensitivity of contrast enhanced magnetic resonance imaging (MRI) in the detection of connective tissue reactions accompanying the maturation of subdural haematomas (SDH) was studied. An outer enhancing layer between the SDH and the tabula interna of the vault was shown in 16 out of 17 cases. In early SDH this outer enhancing layer presumably is due to vascular congestion and/or increased vascular permeability. A thickening of the outer enhancing layer and/or an inner enhancing layer between the haematoma and the subarachnoid space was visible in 9 patients and represented a haematoma capsule formed by proliferating granulation tissue. In 5 SDH septations were found, 3 SDH consisted almost completely of enhancing granulation tissue. Thus, contrast enhanced MRI delivers additional information about the structure of SDH, which are useful for determining the extent of surgical treatment especially in chronic SDH.


Subdural haematoma contrast media magnetic resonance imaging magnetic resonance imaging (MRI) meninges 


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  1. 1.
    Burke JW, Podrasky AE, Bradley WG (1990) Meninges: benign postoperative enhancement on MR Images. Radiology 174: 99–102PubMedGoogle Scholar
  2. 2.
    Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. AJNR 11: 69–76PubMedGoogle Scholar
  3. 3.
    D’Costa DF, Abbott RJ (1990) Bilateral subdural haematomas and normal CT brain scans. Br J Clin Pract 44(12): 666–667PubMedGoogle Scholar
  4. 4.
    Destian S, Heier LA, Zimmerman RD, Morgello S, Deck MD (1989) Differentiation between meningeal fibrosis and chronic subdural hematoma after ventricular shunting: value of enhanced CT and MR scans. AJNR 10: 1021–1026PubMedGoogle Scholar
  5. 5.
    Ebisu T, Naruse S, Horikawa Y, Tanaka C, Higuchi T (1989) Nonacute subdural hematoma: fundamental interpretation of MR images based on biochemical and in vitro MR analysis. Radiology 171 (2): 449–453PubMedGoogle Scholar
  6. 6.
    Fobben ES, Grossman RI, Atlas SW, Hackney DB, Goldberg HI, Zimmerman RA, Bilaniuk LT (1989) MR characteristics of subdural hematomas and hygromas at 1.5 T. AJR 153(3): 589–595PubMedGoogle Scholar
  7. 7.
    Haines DE (1991) On the question of a subdural space. Anat Rec 230: 3–21PubMedCrossRefGoogle Scholar
  8. 8.
    Hosoda K, Tamaki N, Masumura M, Matsumoto S, Maeda F (1987) Magnetic resonance imaging of chronic subdural hematomas. J Neurosurg 67(5): 677–683PubMedGoogle Scholar
  9. 9.
    Kawano N, Endo M, Saito M, Yada K (1988) Origin of the capsule of a chronic subdural hematoma—an electron microscopy study. No Shinkei Geka 16(6): 747–752PubMedGoogle Scholar
  10. 10.
    Kilgore DP, Breger RK, Daniels DL, Pojunas KW, Williams AL, Haughton VM (1986) Cranial tissues: normal MR appearance after intravenous injection of Gd-DTPA. Radiology 160: 757–761PubMedGoogle Scholar
  11. 11.
    Martin DS, Awwad EE, Pittman T (1990) Meningeal fibrosis appearing shortly after ventricular shunting (letter).AJNR 11: 617PubMedGoogle Scholar
  12. 12.
    Mathews VP, Kuharik MA, Edwards MK, D’Amour PG, Azzarelli B, Dreesen RG (1989) Gd-DTPA-enhanced MR imaging of experimental bacterial meningitis: evaluation and comparison with CT. AJR 152: 131–136PubMedGoogle Scholar
  13. 13.
    Moon KL, Brant-Zawadzki M, Pitts LH, Mills CM (1984) Nuclear magnetic resonance imaging of CT-isodense subdural hematomas. AJNR 5(3):319–322PubMedGoogle Scholar
  14. 14.
    Nagasaka M, Omata T, Miyazawa N, Kaneko M, Fukamachi A, Nukui H (1991) Organized chronic subdural hematoma; report of two cases. No Shinkei Geka 19(9): 861–865PubMedGoogle Scholar
  15. 15.
    Petersen D, Grodd W, Voigt K (1989) Kernspintomographie (1.5 T) traumatischer extrazerebraler Hämatome. Radiologe 29(9): 416–422PubMedGoogle Scholar
  16. 16.
    Phillips ME, Ryals TJ, Kambhu SA, Yuh WT (1990) Neoplastic vs inflammatory meningeal enhancement with Gd-DTPA. JCAT 14(4): 536–541Google Scholar
  17. 17.
    Saleh J, Afshar F (1987) Diagnosis of chronic subdural haematoma: the advantages of MRI imaging compared with the CT-scan. Br J Neurosurg 1(3): 369–374PubMedCrossRefGoogle Scholar
  18. 18.
    Sato S, Suzuki J (1975) Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43: 569–578PubMedCrossRefGoogle Scholar
  19. 19.
    Schörner W, Henkes H, Sander B, Felix R (1988) MR-Darstellung der Meningen: normale und pathologische Befunde. RöFo 149(4): 361–368PubMedGoogle Scholar
  20. 20.
    Sipponen JT, Sepponen RE, Sivula A (1984) Chronic subdural hematoma: demonstration by magnetic resonance. Radiology 150(1): 79–85PubMedGoogle Scholar
  21. 21.
    Slowikowski JS, Cooperberg CI, Ruisi JA, Bertino FJ (1989) Superiority of magnetic resonance imaging over computer tomography for diagnosing isodense bilateral subdural hematomas. Am J Med 86(3): 345–346PubMedCrossRefGoogle Scholar
  22. 22.
    Sze G, Soletsky S, Bronen R, Krol G (1989) MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. AJR 153: 1039–1049PubMedGoogle Scholar
  23. 23.
    Virchow R (1857) Das Hämatom der Dura mater. Verhandl Phys Med Gesellsch Würzburg 7: 134–142Google Scholar
  24. 24.
    Wilms G, Marchal G, Geusens E, Raaijmakers C, Van Calenbergh F, Goffin J, Plets C (1992) Isodense subdural hematomas on CT: MRI findings Neuroradiology 34(6): 497–499PubMedCrossRefGoogle Scholar
  25. 25.
    Yamashima T, Yamamoto S (1985) The origin of inner membranes in chronic subdural hematomas. Acta Neuropathol (Berl) 67(3–4): 219–225CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • J. Spreer
    • 1
  • R. -I. Ernestus
    • 2
  • H. Lanfermann
    • 3
  • K. Lackner
    • 3
  1. 1.Section Neuroradiology, Department of Diagnostic RadiologyAlbert-Ludwigs-Universität Freiburg/Brsg.Federal Republic of Germany
  2. 2.Department of NeurosurgeryUniversity of CologneFederal Republic of Germany
  3. 3.Department of RadiologyUniversity of CologneFederal Republic of Germany

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