Anemia Diagnosed by Head Computed Tomography
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Heesun Choi
After several days of generalized weakness, a 79-year-old man presented to the emergency department with a possible head injury due to a fall. He had a cerebral vascular accident several years prior, with residual left-sided weakness. Examination revealed skin pallor but no signs of trauma. Unenhanced head computed tomographic images (UHCT) showed no acute intracranial hemorrhage but demonstrated possible anemia because the dural venous sinus (DVS) had a measurement of 23.6 Hounsfield units (HUs) (image A and image B). His hemoglobin (Hb) level was low (3.1 g/dL). Fecal occult blood was detected, and the patient received a transfusion of 2 units of packed red blood cells.
Attenuation of the DVS on UHCT has been shown to correlate with Hb and hematocrit to predict the degree of anemia.1-4 Chaudhry et al1 found that an attenuation of 36.3 HU (AUC, 0.56) in the DVS had moderate sensitivity (80%), high specificity (96.6%), and negative predictive value (99.6%) for diagnosing anemia (Hb <8 g/dL), and less than 42.35 HU (AUC, 0.94) demonstrated a high sensitivity (91.2%), specificity (88.5%), and negative predictive value (98.6%) for an Hb level less than 10 g/dL. Although Hb affects attenuation more than hematocrit, other factors, including age and sex, should be considered when determining the attenuation of the DVS.3,4 When sex is considered, an increase of 10 HU correlates to a 2.26-g/dL increase in Hb in males and 0.87-g/dL in females.3
References
1. Chaudhry AA , GulM, ChaudhryA, SheikhM, DunkinJ. Quantitative evaluation of noncontrast computed tomography of the head for assessment of anemia. J Comput Assist Tomogr. 2015;39(6):842-848. doi:10.1097/RCT.0000000000000306Suche in Google Scholar PubMed
2. Black DF , RadAE, GrayLA, CampeauNG, KallmesDF. Cerebral venous sinus density on noncontrast CT correlates with hematocrit. AJNR Am J Neuroradiol. 2011;32(7):1354-1357. doi:10.3174/ajnr.A2504Suche in Google Scholar PubMed PubMed Central
3. Bruni SG , PatafioFM, DuftonJA, NolanRL, IslamO. The assessment of anemia from attenuation values of cranial venous drainage on unenhanced computed tomography of the head. Can Assoc Radiol J. 2013;64(1):46-50. doi:10.1016/j.carj.2011.08.005Suche in Google Scholar PubMed
4. Al-Ryalat NT , AlRyalatSA, MalkawiLW, Al-ZeenaEF, NajarMS, HadidyAM. Factors affecting attenuation of dural sinuses on noncontrast computed tomography scan.J Stroke Cerebrovasc Dis.2016:25(10):2559-2565. doi:10.1016/j.jstrokecerebrovasdis.2016.07.002Suche in Google Scholar PubMed
© 2019 American Osteopathic Association
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- Point-of-Care Ultrasonography Integration in Undergraduate Medical Education: A Student-Driven Approach
- OMT MINUTE
- Muscle Energy for the Occipitoatlantal Joint
- EDITORIAL
- Building on WVSOM's Mission of Education and Scholarly Activity
- ORIGINAL CONTRIBUTION
- Advancing Methods of Assessing Bone Quality to Expand Screening for Osteoporosis
- Assessment of Pulmonary Function After Osteopathic Manipulative Treatment vs Standard Pulmonary Rehabilitation in a Healthy Population
- BRIEF REPORT
- Thermal and Mechanical Pain Thresholds of Women With Provoked Localized Vulvodynia: A Pilot Study
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- Prior Knowledge of the Mediterranean Diet Is Associated With Dietary Adherence in Cardiac Patients
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- CASE REPORT
- Death of a Fetus With Myeloproliferative Disorder and Trisomy 21
- CLINICAL IMAGES
- Anemia Diagnosed by Head Computed Tomography
