CT值作为急性硬膜下血肿术中急性脑膨出的预测因子

Computed Tomography Hounsfeld units as a predictor of intraoperative acute encephalocele in acute subdural hematoma

目的评估在急性硬膜下血肿病人基底核层面的脑白质、灰质和上矢状窦后1/3段的CT值,其是否可以作为预测急性术中脑膨出及预后的指标。方法回顾性分析51例急性硬膜下血肿病例资料,其中急性术中脑膨出18例(脑膨出组)和无脑膨出33例(无脑膨出组),测量基底核层面的损伤侧和非损伤侧白质、灰质及上矢状窦后1/3的CT值。51例病人,随访3个月。结果两组病人年龄、手术时间无统计学差异;受伤到手术时间、术前GCS具统计学差异(P<0.01)。脑膨出组上矢状窦后1/3段CT值明显升高,伤侧部位白质及灰质CT值明显降低,差异有统计学意义(P<0.01)。上矢状窦CT值为50.38HU,对术中急性脑膨出的敏感性为100%,特异性为93.9%;ROC曲线下面积是0.98。无脑膨出组病死率12.12%(4/33),脑膨出组病死率高达61.11%(11/18),剩余病人均为重度或严重残疾。结论测量基底核层面白质、灰质和上矢状窦后1/3段的CT值可能有助于预测急性硬膜下血肿术中急性脑膨出的发生,判断病人预后。

Objective To evaluate whether CT Hounsfeld units(HU)of white matter(WM)and gray matter(GM)at the basal ganglia region and posterior one-third of the superior sagittal sinus in patients with acute subdural hematoma can be used as a predictor of acute intraoperative encephalocele and prognosis.Methods The clinical data of 51 patients with acute subdural hematoma were analyzed retrospectively,including 18 with acute intraoperative encephalocele(encephalocele group)and 33 without encephalocele(non-encephalocele group).The CT HU of the injured and non-injured sides of WM,GM and the posterior one-third segment of the superior sagittal sinus at the level of the basal ganglia were measured.All 51 patients were followed up for 3 months.Results There were no statistically significant differences in age and operation time between the two groups,but there were statistically significant differences in the time from injury to operation and preoperative GCS(P<0.01).The CT HU of the posterior one-third segment of the superior sagittal sinus in the encephalocele group were significantly increased,while the CT HU of WM and GM on the injured side were significantly decreased,with statistically significant differences(P<0.01).A CT number of 50.38 HU for the superior sagittal sinus had a sensitivity of 100%and a specificity of 93.9%for predicting acute intraoperative encephalocele.The area under the ROC curve was 0.98.The mortality rate in the non-encephalocele group was 12.12%(4/33),while the mortality rate in the encephalocele group was as high as 61.11%(11/18).The remaining patients had severe or profound disabilities.Conclusion CT HU of WM,GM and the posterior one-third segment of the superior sagittal sinus at the level of the basal ganglia may help predict the occurrence of acute intraoperative encephalocele during surgery for acute subdural hematoma and assess patient prognosis.