Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Clin Neuroradiol. 2022 Dec;32(4):931-938. doi: 10.1007/s00062-022-01162-1. Epub 2022 Apr 29.
Evaluation of chronic subdural hematoma (cSDH) treatment success relies on radiologic measures, in particular hematoma volume, width and midline shift (MLS). Nevertheless, there are no validated standards for MLS measurement in cSDH. Aim of this study was to identify the most reliable measurement location and technique for MLS.
Admission CT scans of 57 patients with unilateral cSDH were retrospectively analyzed. Axial slices were evaluated by 4 raters with MLS measurement in 4 locations, foramen of Monro (FM), thalamus (Th), mid-septum pellucidum (SP), maximum overall MLS (max) with 2 different techniques: displacement perpendicular to anatomical (ideal) midline (MLS-M), and displacement relative to the tabula interna in relation to the width of the intracranial space (MLS-T). Intraclass correlation coefficients (ICC) were calculated to assess interrater reliability and agreement of MLS‑M and MLS‑T measurement techniques. Measurements of cSDH volume and width were conducted for further data alignment.
The ICCs between readers were excellent (> 0.9) for all MLS‑M locations and for MLS-T_Th and ML-T_FM. The ICC was higher for MLS‑M than for MLS‑T in all locations. MLS-M_max showed the highest correlation coefficient of 0.78 with cSDH volume. Variance of MLS-M_max was explained in 64% of cases (adj. R squared) by cSDH volume based on a simple linear regression model. An increase of 10 ml cSDH volume resulted in an average increase of 0.8 mm MLS-M_max.
The MLS measurement in cSDH patients should be standardized, and due to its high interrater reliability, the MLS‑M technique should be preferred.
评估慢性硬脑膜下血肿（cSDH）治疗成功与否依赖于影像学测量，尤其是血肿体积、宽度和中线移位（MLS）。然而，cSDH 中线移位的测量尚无标准。本研究旨在确定 MLS 最可靠的测量位置和技术。
回顾性分析了 57 例单侧 cSDH 患者的入院 CT 扫描。4 名评估者在 4 个位置（Monro 孔（FM）、丘脑（Th）、透明隔中缝（SP）、最大整体 MLS（max））评估轴位切片，使用 2 种不同技术测量 MLS：垂直于解剖学（理想）中线的移位（MLS-M）和相对于内板的移位，与颅内空间的宽度有关（MLS-T）。计算组内相关系数（ICC）评估 MLS-M 和 MLS-T 测量技术的组内一致性和一致性。还对 cSDH 体积和宽度进行了测量，以便进一步对齐数据。
所有 MLS-M 位置以及 MLS-T_Th 和 MLS-T_FM 的读者间 ICC 均为优（>0.9）。MLS-M 的 ICC 均高于所有位置的 MLS-T。MLS-M_max 与 cSDH 体积的相关性最高，相关系数为 0.78。基于简单线性回归模型，cSDH 体积解释了 MLS-M_max 方差的 64%（调整后的 R 平方）。cSDH 体积增加 10ml 导致 MLS-M_max 平均增加 0.8mm。
cSDH 患者的 MLS 测量应标准化，由于 MLS-M 技术具有较高的组内一致性，因此应优先使用该技术。
