Guranda Alexandru, Richter Antonia, Wach Johannes, Güresir Erdem, Vychopen Martin
Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany.
Brain Sci. 2025 Jan 10;15(1):58. doi: 10.3390/brainsci15010058.
Traumatic acute subdural hematoma (aSDH) often requires surgical intervention, such as craniotomy, to relieve mass lesions and pressure. The extent of hematoma evacuation significantly impacts patient outcomes. This study utilizes 3D Slicer software to analyse post-craniotomy hematoma volume changes and evaluate their prognostic significance in aSDH patients. Among 178 adult patients diagnosed with aSDH from January 2015 to December 2022, 64 underwent hematoma evacuation via craniotomy. Initial scans were performed within 24 h of trauma, followed by routine postoperative scans to assess residual hematoma. We conducted radiomic analysis of preoperative and postoperative volumes, surface area, Feret diameter, sphericity, flatness, and elongation. Clinical parameters, including SOFA score, APACHE score, pupillary response, comorbidities, age, anticoagulation status, and preoperative haematocrit and haemoglobin levels, were also evaluated. Changes in Δ surface area significantly correlated with 30-day outcomes ( = 0.03) and showed moderate predictive accuracy (AUC = 0.65). Patients with a Δ surface area > 30,090 mm experienced poorer outcomes (OR = 6.66, = 0.02). Significant features included preoperative surface area ( = 0.009), Feret diameter ( = 0.0012). In multivariate analysis, only the Feret diameter remained significant ( = 0.01). Postoperative Δ surface area is, among other variables, a strong predictor of 30-day outcomes, while in multivariate analysis, preoperative Feret diameter remains the only independent predictor. Radiomic analysis with 3D Slicer may enhance prognostic accuracy and inform tailored therapeutic strategies.
创伤性急性硬膜下血肿（aSDH）通常需要手术干预，如开颅手术，以解除占位性病变和减轻压力。血肿清除的程度对患者的预后有显著影响。本研究利用3D Slicer软件分析开颅术后血肿体积变化，并评估其在aSDH患者中的预后意义。在2015年1月至2022年12月诊断为aSDH的178例成年患者中，64例行开颅血肿清除术。在创伤后24小时内进行初始扫描，随后进行常规术后扫描以评估残余血肿。我们对术前和术后的体积、表面积、费雷特直径、球形度、扁平度和伸长率进行了影像组学分析。还评估了临床参数，包括序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分系统（APACHE）评分、瞳孔反应、合并症、年龄、抗凝状态以及术前血细胞比容和血红蛋白水平。表面积变化（Δ表面积）与30天预后显著相关（P = 0.03），并显示出中等预测准确性（曲线下面积[AUC] = 0.65）。Δ表面积> 30,090 mm²的患者预后较差（比值比[OR] = 6.66，P = 0.02）。显著特征包括术前表面积（P = 0.009）、费雷特直径（P = 0.0012）。在多变量分析中，只有费雷特直径仍然显著（P = 0.01）。术后Δ表面积是30天预后的有力预测指标之一，而在多变量分析中，术前费雷特直径仍然是唯一的独立预测指标。使用3D Slicer进行影像组学分析可能会提高预后准确性，并为定制治疗策略提供依据。
