Takemoto Yushin, Hasegawa Yu, Tashima Kozo, Hashiguchi Akihito, Moroki Koichi, Tokuda Hajime, Mukasa Akitake
Neurosurgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, JPN.
Neurosurgery, Tokuda Neurosurgical Hospital, Kanoya, JPN.
Cureus. 2025 Sep 21;17(9):e92873. doi: 10.7759/cureus.92873. eCollection 2025 Sep.
This study aimed to evaluate whether the initial Hounsfield unit value (IT-HUV), easily obtained from non-contrast CT, serves as a reliable predictor not only for symptomatic vasospasm (SVS) but also for delayed cerebral ischemia (DCI) and overall prognosis in patients with aneurysmal subarachnoid hemorrhage (SAH).
A retrospective cohort of 95 patients with aneurysmal SAH who underwent craniotomy clipping and completed rehabilitation between January 2010 and December 2019 was analyzed. Associations between radiological parameters and functional outcomes (modified Rankin Scale (mRS)), as well as DCI and SVS, were assessed using univariate and multivariate analyses.
Of the included patients, 27 (28.4%) had poor outcomes (mRS 4-5), 20 (21.1%) developed DCI, and 19 (20%) experienced SVS. Significant correlations were observed between IT-HUV and mRS (< 0.01), SAH clearance (= 0.02), and Hijdra sum scores (= 0.03); between DCI and IT-HUV (< 0.01), postoperative HUV (= 0.02), and Hijdra sum scores (< 0.01); and between SVS and all variables (SAH clearance: = 0.04; others: < 0.01). IT-HUV was the strongest radiological predictor for mRS, DCI, and SVS, with optimal thresholds around 46.2-46.9.
IT-HUV provides a practical and reliable imaging biomarker for predicting prognosis, DCI, and SVS in patients with aneurysmal SAH. Incorporating IT-HUV into routine assessments may enhance risk stratification and guide individualized treatment strategies.
本研究旨在评估从非增强CT中容易获得的初始亨氏单位值（IT-HUV）是否不仅可作为症状性血管痉挛（SVS）的可靠预测指标，还可作为动脉瘤性蛛网膜下腔出血（SAH）患者延迟性脑缺血（DCI）及总体预后的可靠预测指标。
对2010年1月至2019年12月期间接受开颅夹闭手术并完成康复的95例动脉瘤性SAH患者进行回顾性队列分析。使用单因素和多因素分析评估放射学参数与功能结局（改良Rankin量表（mRS））以及DCI和SVS之间的关联。
在所纳入的患者中，27例（28.4%）预后不良（mRS 4-5），20例（21.1%）发生DCI，19例（20%）出现SVS。观察到IT-HUV与mRS（<0.01）、SAH清除率（=0.02）和Hijdra总分（=0.03）之间存在显著相关性；DCI与IT-HUV（<0.01）、术后HUV（=0.02）和Hijdra总分（<0.01）之间存在显著相关性；SVS与所有变量之间存在显著相关性（SAH清除率：=0.04；其他：<0.01）。IT-HUV是mRS、DCI和SVS最强的放射学预测指标，最佳阈值约为46.2-46.9。
IT-HUV为预测动脉瘤性SAH患者的预后、DCI和SVS提供了一种实用且可靠的影像学生物标志物。将IT-HUV纳入常规评估可能会加强风险分层并指导个体化治疗策略。
