Kung Woon-Man, Wang Yao-Chin, Chen Wei-Jung, Lin Muh-Shi
Division of Neurosurgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan.
Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan.
Diagnostics (Basel). 2022 Nov 4;12(11):2695. doi: 10.3390/diagnostics12112695.
Evidence suggests that hyperdense (HD) chronic subdural hematomas (CSDHs) have a higher recurrence than hypodense (LD) chronic subdural hematomas. The value of mean hematoma density (MHD) has been proven to be associated with postoperative recurrence. The MHD levels in homogeneous CSDHs likely underestimate the risk of recurrence in HD homogeneous subtypes. This study investigated 42 consecutive CSDH cases between July 2010 and July 2014. The area of the hematoma was quantified to determine the MHD level using computer-based image analysis of preoperative brain CT scans. In terms of the MHD distribution of the four types of CSDHs (homogeneous, laminar, separated, and trabecular), wide 95% CI (11.80-16.88) and high standard deviation (4.59) can be found in homogeneous types, reflecting a high variability in the MHD levels between cases (from low to high density). The categorization of homogeneous types into LD and HD (type five) displayed a minor standard deviation in the MHD levels for LD and HD subtypes (1.15, and 0.88, respectively). MHD values demonstrated concentrated distributions among the respective five types, compared to the four-type setting. In the current research, we provide a consideration that if LD and HD hematomas are separated from homogeneous CSDHs, the variability of the MHD quantification can potentially be reduced, thereby avoiding the possibility of undetected high-risk groups.
有证据表明，高密度（HD）慢性硬膜下血肿（CSDH）的复发率高于低密度（LD）慢性硬膜下血肿。平均血肿密度（MHD）值已被证明与术后复发有关。均匀性CSDH中的MHD水平可能低估了HD均匀性亚型的复发风险。本研究调查了2010年7月至2014年7月期间连续的42例CSDH病例。通过对术前脑部CT扫描进行基于计算机的图像分析，对血肿面积进行量化以确定MHD水平。就四种类型的CSDH（均匀性、层状、分隔性和小梁状）的MHD分布而言，均匀性类型中可发现较宽的95%置信区间（11.80 - 16.88）和较高的标准差（4.59），这反映了病例之间MHD水平的高度变异性（从低密度到高密度）。将均匀性类型分为LD和HD（第五种类型）后，LD和HD亚型的MHD水平标准差较小（分别为1.15和0.88）。与四种类型的情况相比，MHD值在各自的五种类型中呈现集中分布。在当前研究中，我们提出一种考虑，即如果将LD和HD血肿与均匀性CSDH区分开来，MHD量化的变异性可能会降低，从而避免未被发现的高风险组的可能性。
