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

• Published in: Brain injury Vol. 28; no. 8; p. 1121
• Main Authors: Xu, Fei-Fan, Chen, Jin-Hong, Leung, Gilberto Ka Kit, Hao, Shu-Yu, Xu, Long, Hou, Zong-Gang, Mao, Xiang, Shi, Guang-Zhi, Li, Jing-Sheng, Liu, Bai-Yun
• Format: Journal Article
• Language: English
• Published: England 01.01.2014
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Decompressive Craniectomy; Female; Follow-Up Studies; Hematoma, Subdural, Chronic - diagnostic imaging; Hematoma, Subdural, Chronic - pathology; Hematoma, Subdural, Chronic - prevention & control; Humans; Male; Middle Aged; Pilot Projects; Postoperative Period; Predictive Value of Tests; Prospective Studies; Recurrence; Risk Assessment; Subdural Space - diagnostic imaging; Subdural Space - pathology; Tomography, X-Ray Computed; recurrence; computer-assisted volumetric analysis; Chronic subdural haematoma; outcome; computer tomography
• ISSN: 1362-301X
• DOI: 10.3109/02699052.2014.910702

Post-operative volume of subdural fluid is considered to correlate with recurrence in chronic subdural haematoma (CSDH). Information on the applications of computer-assisted volumetric analysis in patients with CSDHs is lacking. To investigate the relationship between haematoma recurrence and longitudinal changes in subdural fluid volume using CT volumetric analysis. Fifty-four patients harbouring 64 CSDHs were studied prospectively. The association between recurrence rate and CT findings were investigated. Eleven patients (20.4%) experienced post-operative recurrence. Higher pre-operative (over 120 ml) and/or pre-discharge subdural fluid volumes (over 22 ml) were significantly associated with recurrence; the probability of non-recurrence for values below these thresholds were 92.7% and 95.2%, respectively. CSDHs with larger pre-operative (over 15.1 mm) and/or residual (over 11.7 mm) widths also had significantly increased recurrence rates. Bilateral CSDHs were not found to be more likely to recur in this series. On receiver-operating characteristic curve, the areas under curve for the magnitude of changes in subdural fluid volume were greater than a single time-point measure of either width or volume of the subdural fluid cavity. Close imaging follow-up is important for CSDH patients for recurrence prediction. Using quantitative CT volumetric analysis, strong evidence was provided that changes in the residual fluid volume during the 'self-resolution' period can be used as significantly radiological predictors of recurrence.