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CT-Based Assessment of Brain Edema May Predict Which Patients with Traumatic Brain Injury May Benefit from Tranexamic
Maguy Farhat1, Samir A Dagher1, Susan Rowell2
1From the Department of Neuroradiology (M.F., S.A.D., P.K., M.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas.
AJNR. American Journal of Neuroradiology
|March 12, 2026
Summary
Tranexamic acid (TXA) shows a survival benefit in traumatic brain injury (TBI) patients with over 3% vasogenic edema on CT scans. This imaging tool helps identify patients who may benefit from prehospital TXA administration.
Area of Science:
- Neuroscience
- Radiology
- Emergency Medicine
Background:
- Traumatic brain injury (TBI) can cause vasogenic edema, potentially impacting patient survival.
- Tranexamic acid (TXA) is being investigated for its potential to mitigate TBI-related edema and improve outcomes.
- Identifying specific patient subgroups who benefit from TXA is crucial for effective treatment.
Purpose of the Study:
- To evaluate a CT-based quantitative imaging tool for identifying acute TBI patients who may benefit from prehospital TXA.
- To determine if a specific percentage of vasogenic edema on CT scans correlates with a survival benefit from TXA.
Main Methods:
- Post hoc analysis of the Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial.
- CT images analyzed using a Matlab-based algorithm to quantify brain voxels within the 10-20 HU density range (vasogenic edema).
- Logistic regression and threshold analysis to assess the relationship between edema percentage and in-hospital mortality with TXA use.
Main Results:
- A significant interaction (P = .04) was found between TXA use and survival based on the percentage of brain voxels in the 10-20 HU range.
- A threshold of ≥3% voxels in the 10-20 HU range (approx. 40 mL edema) identified patients with a significant survival benefit from TXA (P = .04).
- In this subgroup, TXA reduced the relative risk of mortality by 0.59 (95% CI, 0.17-0.99) compared to placebo.
Conclusions:
- A CT finding of ≥3% brain parenchymal voxels in the 10-20 HU range is a promising biomarker for TXA survival benefit in acute TBI.
- This quantitative imaging approach may aid in personalized prehospital TBI management.
- Prospective validation is necessary to confirm these findings for clinical implementation.
