Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun 7:24:83.
doi: 10.1186/s13049-016-0271-y.

Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema

Hitoshi Yamamura  1 , Takasei Morioka  2 , Tomonori Yamamoto  2 , Yasumitsu Mizobata  2
Affiliations

Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema

Hitoshi Yamamura et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: The ability to predict outcome in patients with cerebral edema is important because it can influence treatment strategy. We evaluated whether differences in head computed tomographic (CT) measurements in Hounsfield units (HU) of white matter and gray matter can be used as a predictor of outcome in patients with subdural hematoma with cerebral edema.

Methods: We evaluated 34 patients who had subdural hematoma with cerebral edema following acute closed head trauma and had undergone head CT within a few hours of admission. We divided them into the survival (n = 24) group and death (n = 10) group, and measured the HU of white matter and gray matter at injury and non-injury sites.

Results: There were no significant differences in operation time or blood loss during surgery between the two groups. Only the HU of white matter in the injury site of patients in the death group were decreased significantly. A cut-off value of 31.5 for HU of white matter showed 80.0 % sensitivity and 99.9 % specificity for death; the area under the curve was 0.91.

Discussion: Our results are more evidence of the support of neurogenic edema in trauma rather than an important clinical tool at this stage. However, HU values in WM may be one factor in the decision-making process that affects patient outcome. Changing the treatment strategy in patients with a low HU value in the WM at the injury site may bring about an improvement in patient outcome.

Conclusion: Measurement in HU of white matter at the injury site might be useful as a predictor of outcome in patients with subdural hematoma with cerebral edema.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The measurement for Hounsfield units of grey matter (circle) and white matter (triangle) (left panel). The measurement for the displaced distance from the median (right panel)
Fig. 2
Fig. 2
Hounsfield units (HU) of the injury site. The value of HU of white matter in the survival group was significantly higher than that in the death group (33.9 [2.7] vs. 29.5 [3.4] HU) (p <0.01)
Fig. 3
Fig. 3
Hounsfield units of non-injury sites. There was no significant difference in the value of Hounsfield units of the grey matter or white matter between the survival group and the death group
Fig. 4
Fig. 4
Results of the displaced distance from the median. There was no significant difference in the displaced distance from the median between the survival group and the death group
Fig. 5
Fig. 5
Receiver operating characteristic curve analysis for Hounsfield units of white matter at the injury site. A cut-off value of 31.5 for Hounsfield units of white matter showed 80.0 % sensitivity and 99.9 % specificity for predicting death. The area under the curve was 0.91
See this image and copyright information in PMC

References

    1. Kim H, Kim GD, Yoon BC, Kim K, Kim BJ, Choi Y, Czosnyka M, Oh BM, Kim DJ. Quantitative analysis of computed tomography images and early detection of cerebral edema for pediatric traumatic brain injury patients: retrospective study. BMC Med. 2014;12:186. doi: 10.1186/s12916-014-0186-2. - DOI - PMC - PubMed
    1. Michiue T, Sakurai T, Ishikawa T, Oritani S, Maeda H. Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death. Forensic Sci Int. 2012;220:232–8. doi: 10.1016/j.forsciint.2012.03.007. - DOI - PubMed
    1. Yuh EL, Cooper SR, Ferguson AR, Manley GT. Quantitative CT improves outcome prediction in acute traumatic brain injury. J Neurotrauma. 2012;29:735–46. doi: 10.1089/neu.2011.2008. - DOI - PMC - PubMed
    1. Chieregato A, Fainardi E, Morselli-Labate AM, Antonelli V, Compagnone C, Targa L, Kraus J, Servadei F. Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery. 2005;56:671–80. doi: 10.1227/01.NEU.0000156200.76331.7A. - DOI - PubMed
    1. Huang AP, Lee CW, Hsieh HJ, Yang CC, Tsai YH, Tsuang FY, Kuo LT, Chen YS, Tu YK, Huang SJ, et al. Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. J Trauma. 2011;71:1593–9. doi: 10.1097/TA.0b013e31822c8865. - DOI - PubMed

MeSH terms