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

Liu Haibing; Liu Changchun; Xu Mingwei; Wei Liangfeng; Hong Jingfang; Wang Shousen; Xue Liang

doi:10.11850/j.issn.1009-122X.2024.02.002

Abstract：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.