Neshige Shuichiro, Kuriyama Masaru, Ota Shinzo
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical and Health Sciences, Japan; Department of Neurology, Stroke Center, Ota Memorial Hospital, Japan.
Department of Neurology, Stroke Center, Ota Memorial Hospital, Japan.
J Neurol Sci. 2024 Dec 15;467:123324. doi: 10.1016/j.jns.2024.123324. Epub 2024 Nov 22.
To identify the brain magnetic resonance imaging (MRI) findings associated with the postoperative recurrence of chronic subdural hematoma (CSDH).
We examined 1099 consecutive patients admitted to our hospital with CSDH between 2005 and 2014. Of those, 1021 who underwent surgery for CSDH and were followed-up for >3 months after surgery were included. Preoperative brain MRI findings were classified as homogeneous, laminar, separate, or trabecular, according to the nature of the hematoma. Postoperative recurrence was defined in patients who required reoperation for ipsilateral hematoma growth within three months of surgery. The clinical and radiological factors associated with postoperative recurrence were evaluated using univariate and multivariate analyses.
Of the 1021 CSDH patients with CSDH who underwent surgery, 91 (8.9%) experienced postoperative recurrence. Postoperative recurrence was significantly associated with male sex (p = 0.0004) and hematoma volume (p < 0.0001). Additionally, isotype or separate types of hematoma on computed tomography (CT) (p < 0.0001) and laminar/separate types of hematoma types on MRI (p = 0.0008) were significant. Multivariate analysis revealed odds ratios of 2.50 (95% CI, 1.45-4.61; p = 0.0007) for male sex and 3.05 (95% CI, 1.95-4.87; p < 0.0001) for iso/separate hematoma types in CT. Conversely, among the patients who underwent MRI, multivariate analysis revealed odds ratios of 4.33 (95% CI, 1.20-27.92; p = 0.001) for male sex and 4.88 (95% CI, 1.90-14.18; p = 0.023) for laminar/separate hematoma types.
While distinguishing the nature of hematomas is challenging with brain CT examination, detailed laminar/trabecular differentiation using MRI images may predict postoperative recurrence.
确定与慢性硬膜下血肿（CSDH）术后复发相关的脑磁共振成像（MRI）表现。
我们检查了2005年至2014年间连续收治的1099例CSDH患者。其中，1021例接受了CSDH手术并在术后随访超过3个月的患者被纳入研究。根据血肿的性质，术前脑MRI表现分为均匀型、层状型、分隔型或小梁型。术后复发定义为在手术后三个月内因同侧血肿增大而需要再次手术的患者。使用单因素和多因素分析评估与术后复发相关的临床和放射学因素。
在1021例接受CSDH手术的患者中，91例（8.9%）出现术后复发。术后复发与男性性别（p = 0.0004）和血肿体积（p < 0.0001）显著相关。此外，计算机断层扫描（CT）上血肿为等密度或分隔型（p < 0.0001）以及MRI上血肿为层状/分隔型（p = 0.0008）具有显著意义。多因素分析显示，男性性别的比值比为2.50（95%可信区间，1.45 - 4.61；p = 0.0007），CT上等密度/分隔型血肿类型的比值比为3.05（95%可信区间，1.95 - 4.87；p < 0.0001）。相反，在接受MRI检查的患者中，多因素分析显示男性性别的比值比为4.33（95%可信区间，1.20 - 27.92；p = 0.001），层状/分隔型血肿类型的比值比为4.88（95%可信区间，1.90 - 14.18；p = 0.023）。
虽然通过脑CT检查区分血肿的性质具有挑战性，但使用MRI图像进行详细的层状/小梁区分可能预测术后复发。
