Statistical relevance of mean hematoma density and it's internal architecture: Potential clinical application in chronic subdural hematomas
Tzu-Yung Chen1, Sue-Ting Chang2, Muh-Shi Lin3
1 Department of Surgery, Division of Neurosurgery, Kuang Tien General Hospital; Department of Nursing, College of Nursing, Hung Kuang University, Taichung, Taiwan
2 Department of Technology Application and Human Resource Development, National Taiwan Normal University, Taipei; Department of Administration, Kuang-Tien General Hospital, Taichung, Taiwan
3 Department of Surgery, Division of Neurosurgery, Kuang Tien General Hospital, Taichung; Department of Biotechnology and Animal Science, College of Bioresources, National Ilan University, Yilan; Department of Biotechnology, College of Medical and Health Care, Hung Kuang University, Taichung, Taiwan
Dr. Muh-Shi Lin
Department of Surgery, Division of Neurosurgery, Kuang Tien General Hospital, No. 117, Shatian Road, Shalu, Taichung 433
Source of Support: None, Conflict of Interest: None
Background: The postoperative recurrence rate of chronic subdural hematomas (CSDHs) ranges from 9% to 20%, which is a serious concern for neurosurgeons. Both qualitative and quantitative assessment methods have been developed to identify the mechanisms involved in postoperative recurrence. These methods include Nakaguchi's clinical classification scheme and the quantification of mean hematoma density (MHD). This is the first study to examine the correlations between the quantification of MHD and Nakaguchi's clinical classification of patients with CSDHs.
Materials and Methods: This study investigated 35 consecutive cases of CSDH between July 2010 and July 2013. In accordance with Nakaguchi's clinical classification, CSDH cases were separated into four groups: homogenous, laminar, separated, and trabecular. In addition, we quantified the area of the hematoma according to MHD using a computer-based image analysis of preoperative brain computed tomography scans.
Results: The mean age of patients was 72.2 ± 8.05 years (range: 55–86). Mean MHD values were as follows: trabecular (12.45 ± 0.72 HU), homogenous (14.46 ± 4.51 HU), laminar (25.99 ± 0.93 HU), and separated (36.32 ± 3.04 HU). Differences in MHD were statistically significant for all CSDH types (P < 0.001, ANOVA with Student–Newman–Keuls post hoc test), and we observed a significant linear relationship between MHD and the priority order of clinical CSDH types determined according to postoperative recurrence (Spearman's rank correlation coefficient = 0.842, P < 0.001).
Conclusions: This study provides statistical evidence that MHD is significantly correlated with Nakaguchi's clinical classification of CSDH. The applications of MHD quantification and hematoma's internal architecture helped to gain better understanding of possible mechanisms underlying CSDH recurrence.