Quantitative computer tomography analysis of post-operative subdural fluid volume predicts recurrence of chronic subdural haematoma

Xu, Fei; Chen, Jinhong; Leung, Gilberto Ka Kit; Hao, Shuyu; Xu, Liang; Hou, Zhiyong; Mao, Xiang; Shi, Guangzhi; Li, Jingsheng; Liu, Baiyun

doi:10.3109/02699052.2014.910702

Cited by 16 publications

(12 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…volume than bilateral SDH in a separate patient (14). Similarly, Xu et al (15) showed that bilateral cSDH were not associated with recurrence; however, with 44 bilateral cases and 10 unilateral cases, the number of patients in that study was small. In contrast, Shen et al (16), reviewed 102 patients where bilateral cSDH was an independent risk factor for recurrence.…”

Section: Discussionmentioning

confidence: 83%

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

et al. 2020

View full text Add to dashboard Cite

The aging of the western population and the increased use of oral anticoagulation (OAC) and antiplatelet drugs (APD) will result in a clinical dilemma on how to balance the recurrence risk of chronic subdural hematoma (cSDH) with the risk of withholding blood thinners. Objective: To identify features that predicts recurrence, thromboembolism (TEE), hospital stay and mortality. To identify the optimal window for resuming APD or OAC. Methods: We performed a retrospective multivariate analysis of a prospectively collected database. We then build machine learning models for outcomes prediction. Results: We identified 596 patients. The rate of recurrence was 22.17%, that of thromboembolism was 0.9% and that of mortality was 14.78%. Smoking, platelet dysfunction, CKD, and alcohol use were independent predictors of higher recurrence, while resolution of the SDH was protective. OAC use had higher odds of developing TEEs. CKD, developing a new neurological deficit or a TEEs were independent predictors of higher mortality. We find the optimal time of resuming OAC to be after 2 days but before 21 days as these patients had the lowest recurrence of bleeding associated with a low risk of stroke. The ML model achieved an accuracy of 93, precision of 0.84 and recall of 0.80 for recurrence prediction. ML models for hospital stay performed poorly (R 2 = 0.33). ML model for stroke was overfitted given the low number of events. Conclusion: ML modeling is feasible. However, large well-designed prospective multicenter studies are needed for accurate ML so that clinicians can balance the risks of recurrence with the risk of TEEs, especially for high-risk anticoagulated patients.

show abstract

Section: Discussionmentioning

confidence: 83%

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

et al. 2020

View full text Add to dashboard Cite

show abstract

“… 16 Therefore, it was not surprising when recent studies, through more sophisticated quantitative volumetric analyses of CT scans in patients with CSDH, demonstrated that a large V 1 and large V 2 , regardless of whether the lesions were unilateral or bilateral, may be predictors of recurrence. 6 , 17 …”

Section: Discussionmentioning

confidence: 99%

A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Reoperation After Initial Burr-Hole Surgery

2017

View full text Add to dashboard Cite

BACKGROUNDThere is no widely adopted grading system for the prediction of postoperative recurrence requiring reoperation (RrR) in patients with chronic subdural hematoma (CSDH).OBJECTIVEWe developed a CSDH grading system to predict RrR based on predictive characteristics that can be objectively assessed at the time of first presentation and initial surgery.METHODSProspectively collected data from 107 consecutive surgical patients with CSDH were reviewed. Predictors of RrR were identified via logistic and lasso regression analyses. A prognostic CSDH grading system was proposed, with the weighing of predictors based on strength of association. The scoring system was then applied to the same set of patients in our database for internal validation.RESULTSThe strongest predictors of RrR were an isodense or hyperdense lesions and laminar or separated lesions, and a postoperative CSDH cavity volume greater than 200 mL. The moderate predictors of RrR were a postoperative CSDH cavity volume of 80 to 200 mL and a preoperative CSDH volume greater than 130 mL. According to the prognostic CSDH grading system, no patients with a score of 0 points had RrR. RrR was observed in 6% of patients with a score of 1 to 2 points, 30% of patients with a score of 3 to 4 points, and 63% of patients with a score of 5 points (ie, the maximum score). The rate of RrR increased steadily with increases in the prognostic CSDH grading score (P < .001).CONCLUSIONThe prognostic CSDH grading system is an applicable tool for RrR risk stratification in patients with CSDH.

show abstract

“…In contrast, semiautomatic quantitative radiological analysis is a valid predictor of functional outcomes in other neurological conditions like aneurysmal subarachnoid hemorrhage or traumatic brain injury 23,36,37 . Additionally, prior studies have shown the relevance of using these accurate quantitative methods to optimize the surgical evacuation of CSDH 13‐17,38 …”

Section: Discussionmentioning

confidence: 99%

“…Instead, accurate prediction of postoperative outcomes warrants a multidisciplinary approach weighing radiographic, etiologic, and management‐related factors. Although quantitative volumetric and texture analyses of computed tomography (CT) images have been previously used to predict the risk of recurrence in CSDH, 13‐17 there are limited data correlating this approach to functional outcome. Therefore, the objective of this study was to determine whether preoperative CT could serve as an objective and accurate complementary test for prognostication of short‐term postoperative outcomes for patients with CSDH.…”

Section: Introductionmentioning

confidence: 99%

Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma

Martínez-Pérez

Kortz

Ung

et al. 2021

Acta Neuro Scandinavica

View full text Add to dashboard Cite

Objectives There is a lack of evidence demonstrating the utility of computed tomography (CT) to predict chronic subdural hematoma (CSDH) clinical outcomes. We aim to analyze the role of tomographic volumetric analysis in patients with CSDH. Methods We performed a retrospective study of patients undergoing burr‐hole craniostomy (BHC) for CSDH over five years at a tertiary care center. Degree of midline shift, radiographic density, subdural hematoma volume, acute blood volume, and third ventricle (3VV) and fourth ventricle (4VV) volume were estimated using semiautomatic segmentation of preoperative CT. Postoperative functional outcome was measured by two endpoints: National Institute of Health Stroke Scale (NIHSS) at discharge and short‐term modified Rankin Scale (mRS) at 6‐week follow‐up. Univariate and multivariate analyses were performed using nonparametric tests. Discriminative capacity and optimal thresholds of independent variables were calculated by means of receiving‐operative curves (ROC). Results A total of 79 patients were included for analysis with a median age of 78.5 years. Greater preoperative 3VV independently correlated with poor discharge NIHSS (p = .01) and short‐term mRS (p = .03). A cutoff value of 0.545 mL demonstrated the highest sensitivity (77.1%) and specificity (88.8%) with an odds ratio for an mRS functional dependence of 9.29 (p = .001). Conclusions Greater preoperative tomographic 3VV independently prognosticates poor discharge NIHSS and 6‐week mRS. A threshold 3VV of 0.545 mL can be used to identify patients at higher risk of being dependent at first protocolized follow‐up.

show abstract

Quantitative computer tomography analysis of post-operative subdural fluid volume predicts recurrence of chronic subdural haematoma

Cited by 16 publications

References 25 publications

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

Predicting Chronic Subdural Hematoma Recurrence and Stroke Outcomes While Withholding Antiplatelet and Anticoagulant Agents

A Reliable Grading System for Prediction of Chronic Subdural Hematoma Recurrence Requiring Reoperation After Initial Burr-Hole Surgery

Third Ventricle Volume Predicts Functional Outcome in Chronic Subdural Hematoma

Contact Info

Product

Resources

About