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Wu B, Zhang J, Chen J, Sun X, Tan D. Establishment of a model to predict mortality after decompression craniotomy for traumatic brain injury. Brain Behav 2024; 14:e3492. [PMID: 38641890 PMCID: PMC11031634 DOI: 10.1002/brb3.3492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 02/24/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The mortality rate of patients with traumatic brain injury (TBI) is still high even while undergoing decompressive craniectomy (DC), and the expensive treatment costs bring huge economic burden to the families of patients. OBJECTIVE The aim of this study was to identify preoperative indicators that influence patient outcomes and to develop a risk model for predicting patient mortality by a retrospective analysis of TBI patients undergoing DC. METHODS A total of 288 TBI patients treated with DC, admitted to the First Affiliated Hospital of Shantou University Medical School from August 2015 to April 2021, were used for univariate and multivariate logistic regression analysis to determine the risk factors for death after DC in TBI patients. We also built a risk model for the identified risk factors and conducted internal verification and model evaluation. RESULTS Univariate and multivariate logistic regression analysis identified four risk factors: Glasgow Coma Scale, age, activated partial thrombin time, and mean CT value of the superior sagittal sinus. These risk factors can be obtained before DC. In addition, we also developed a 3-month mortality risk model and conducted a bootstrap 1000 resampling internal validation, with C-indices of 0.852 and 0.845, respectively. CONCLUSIONS We developed a risk model that has clinical significance for the early identification of patients who will still die after DC. Interestingly, we also identified a new early risk factor for TBI patients after DC, that is, preoperative mean CT value of the superior sagittal sinus (p < .05).
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Affiliation(s)
- Birui Wu
- Department of NeurosurgeryGuangdong Sanjiu Brain HospitalGuangzhouGuangdongChina
| | - Juntao Zhang
- Department of NeurosurgeryThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Junchen Chen
- Department of NeurosurgeryThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
| | - Xibo Sun
- Department of NeurosurgeryGuangdong Sanjiu Brain HospitalGuangzhouGuangdongChina
| | - Dianhui Tan
- Department of NeurosurgeryThe First Affiliated Hospital of Shantou University Medical CollegeShantouGuangdongChina
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Yamakuni R, Sekino H, Saito M, Kakamu T, Takahashi K, Hara J, Suenaga H, Ishii S, Fukushima K, Ito H. Prediction of Anemia From Cerebral Venous Sinus Attenuation on Deep-Learning Reconstructed Brain Computed Tomography Images. J Comput Assist Tomogr 2023; 47:796-805. [PMID: 37707411 DOI: 10.1097/rct.0000000000001479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate whether the prediction of anemia is possible using quantitative analyses of unenhanced cranial computed tomography (CT) with deep learning reconstruction (DLR) compared with conventional methods. METHODS This cross-sectional retrospective study included 116 participants (76 males; mean age, 66.7) who had hemoglobin (Hb) levels obtained within 24 hours of unenhanced cranial CT, which included 2 reconstruction methods: DLR and hybrid iterative reconstruction. Regions of interest were the confluence of sinuses (CoS) and the right and left transverse sinuses. In addition, edge rise distance of cerebrospinal fluid and venous was measured. RESULTS Spearman rank correlation coefficient demonstrated a positive association between Hb levels and sinus attenuation values. Among these, the CoS in DLR had the best correlation ( r = 0.703, P < 0.001). For the prediction of anemia (Hb < 11 g/dL), the area under the curve of CoS in DLR (area under the curve = 0.874; 95% confidence interval, 0.798-0.949; P < 0.001) was the highest; however, there were no significant differences among reconstruction method and sinus. The attenuation values of DLR were significantly higher than those of hybrid iterative reconstruction ( P < 0.001, paired t test), and the differences between the 2 methods were 4.1 (standard deviation [SD], 1.6) for CoS, 5.2 (SD, 2.2) for right transverse sinuses, and 5.8 (SD, 2.4) for left transverse sinuses. The signal-to-noise ratio ( P < 0.001, paired t test) and edge rise distance ( P < 0.001, Wilcoxon signed rank test) of DLR was significantly higher. CONCLUSIONS Higher CT attenuation values should be considered for predicting anemia based on brain DLR images.
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Affiliation(s)
- Ryo Yamakuni
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Hirofumi Sekino
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Masaki Saito
- Department of Radiology, Fukushima Medical University Hospital
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Junko Hara
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Hiroki Suenaga
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Shiro Ishii
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Kenji Fukushima
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
| | - Hiroshi Ito
- From the Department of Radiology and Nuclear Medicine, Fukushima Medical University School of Medicine
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Fallah Arzpeyma S, Kazemnezhad-Leili E, Rashidi H, Ghorbani-Shirkouhi S, Saberi A. Factors Contributing to Attenuation of Cerebral Venous Sinus in Brain Noncontrast Computed Tomography Scan. Indian J Radiol Imaging 2022; 31:882-887. [PMID: 35136500 PMCID: PMC8817799 DOI: 10.1055/s-0041-1741048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Aim
In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT.
Material and Methods
Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05.
Results
Hematocrit (B = 0.251,
p
< 0.001), hemoglobin (B = 0.533,
p
< 0.001), and creatinine (B = − 0.270,
p
= 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (
p
< 0.001) and hemoglobin (
p
< 0.001) were determined as positive predictors, and creatinine (
p
< 0.001) and BUN (
p
< 0.002) were determined as negative and positive predictors, respectively.
Conclusion
Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases.
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Affiliation(s)
- Sima Fallah Arzpeyma
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leili
- Clinical Statistics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosna Rashidi
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghorbani-Shirkouhi
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Cerebral Venous Thrombosis: A Challenging Diagnosis; A New Nonenhanced Computed Tomography Standardized Semi-Quantitative Method. Tomography 2021; 8:1-9. [PMID: 35076628 PMCID: PMC8788512 DOI: 10.3390/tomography8010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) on non-contrast CT (NCCT) is often challenging to detect. We retrospectively selected 41 children and 36 adults with confirmed CVST and two age-matched control groups with comparable initial symptoms. We evaluated NCCT placing four small circular ROIs in standardized regions of the cerebral dural venous system. The mean and maximum HU values were considered from each ROI, and the relative percentage variations were calculated (mean % variation and maximum % variation). We compared the highest measured value to the remaining three HU values through an ad-hoc formula based on the assumption that the thrombosed sinus has higher attenuation compared with the healthy sinuses. Percentage variations were employed to reflect how the attenuation of the thrombosed sinus deviates from the unaffected counterparts. The attenuation of the affected sinus was increased in patients with CVST, and consequently both the mean % and maximum % variations were increased. A mean % variation value of 12.97 and a maximum % variation value of 10.14 were found to be useful to distinguish patients with CVST from healthy subjects, with high sensitivity and specificity. Increased densitometric values were present in the site of venous thrombosis. A systematic, blind evaluation of the brain venous system can assist radiologists in identifying patients who need or do not need further imaging.
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Digge P, Patel V, Bharath KV, Prakashini KK, Patil KH. Objective Evaluation of Cerebral Venous Sinus Attenuation on Plain CT Brain and Detecting Anemia. Noticing the "Unnoticed". Neurol India 2021; 69:874-878. [PMID: 34507404 DOI: 10.4103/0028-3886.323896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Plain computed tomography (CT) of the brain is an important first-line investigation of choice in an acute neurologic setup. Unless clinically suspected concealed areas like the confluence of venous sinuses often go unnoticed. Diagnosing anemia, thrombosis, or polycythemia correlating the CT attenuation values might prove to be fruitful in early patient management where the mode of varied clinical presentations causes a clinical dilemma. Aims 1) To determine the objective correlation between CT attenuation of the cerebral venous sinus and hemoglobin (Hb) as well as hematocrit (HCT) value and 2) to detect anemia from measuring venous sinus attenuation. Methods and Materials An exploratory study design of 200 patients, who had plain CT of the head and Hb and HCT levels obtained within 24 h of the scan. Statistical Analysis Used Two-tailed unpaired t-test was used to test the difference between two independent samples. Correlation and regression analyses were used to assess the correlation between two quantitative variables. Results A significant correlation was observed between the Hb-Hounsfield unit (HU) and HCT-HU. The simple linear regression model revealed that HU (P value < 0.001) was significantly correlated with Hb and the regression model was, Hb = 2.1 + 0.2 × HU. Similarly, HU (P value < 0.001) was significantly correlated with HCT and regression model was HCT = 6.2 + 0.7 × HU. Conclusions Objective attenuation values of dural sinuses on plain CT can be positively correlated with Hb and HCT values. Considering the cutoff of 35.5 HU, we were able to show the specificity of 100% for the detection of anemia.
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Affiliation(s)
- Poornima Digge
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Viral Patel
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - K V Bharath
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Koteshwar K Prakashini
- Department of Anaesthesia and Critical Care, Kasturba Medical College (KMC), Manipal, Karnataka, India
| | - Karamchand H Patil
- Department of Radio-Diagnosis, Kasturba Medical College (KMC), Manipal, Karnataka, India
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Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis. Sci Rep 2020; 10:883. [PMID: 31965025 PMCID: PMC6972746 DOI: 10.1038/s41598-020-57867-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022] Open
Abstract
Acute cerebral vein thrombosis is usually seen as increased attenuation in brain non-contrast computed tomography. It is so helpful to define measurable parameters for subjective evaluation of sinus thrombosis in non-enhanced brain computed tomography, especially where advanced neuroimaging techniques are not available. The purpose of this study is to evaluate the diagnostic value of venobasilar attenuation ratio and venobasilar attenuation difference in the evaluation of acute cerebral venous sinuous thrombosis in non-enhanced brain CT scan. Fifty confirmed cases of acute cerebral vein thrombosis were sex- and age-matched with 73 subjects who did not have the condition. Average venous sinus attenuation, Hounsfield to hematocrit ratio, basilar artery density, venobasilar attenuation ratio and venobasilar attenuation difference were measured. Mean attenuation was 65.8 in thrombosed and 44.9 in non-thrombosed sinuses (P < 0.0001). A cutoff absolute sinus attentuaion of 61 HU led to a sensitivity of 82%, specificity of 100% and accuracy of 92%. A cutoff ratio of 1.4 for venobasilar ratio led to a sensitivity of 100%, specificity of 78% and accuracy of 87%. A cut-off value of 24 for venobasilar difference resulted in the sensitivity of 80%, specificity of 100% and accuracy of 92%. The additional measurement of venous sinus and basilar artery attenuations and calculation of venobasilar ratio and difference can increase the sensitivity and specificity of NCCT in the diagnosis of acute CVST.
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Quantitative Evaluation of Noncontrast Computed Tomography of the Head for Assessment of Anemia. J Comput Assist Tomogr 2015; 39:842-8. [DOI: 10.1097/rct.0000000000000306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coulier B, Van den Broeck S, Deprez FC. Extreme Anemia Causing Unusual "Black-out" of the Cerebral Vessels on Noncontrast Brain CT. Clin Neuroradiol 2014; 25:197-9. [PMID: 24788299 DOI: 10.1007/s00062-014-0306-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- B Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Bouge, 5004, Namur, Belgium,
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Noncontrast computed tomographic Hounsfield unit evaluation of cerebral venous thrombosis: a quantitative evaluation. Neuroradiology 2013; 55:941-945. [DOI: 10.1007/s00234-013-1194-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Lee SY, Cha SH, Lee SH, Shin DI. Evaluation of the effect of hemoglobin or hematocrit level on dural sinus density using unenhanced computed tomography. Yonsei Med J 2013; 54:28-33. [PMID: 23225795 PMCID: PMC3521278 DOI: 10.3349/ymj.2013.54.1.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). MATERIALS AND METHODS Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. RESULTS The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). CONCLUSION Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.
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Affiliation(s)
- Seung Young Lee
- Department of Radiology, College of Medicine, Chungbuk National University, Heungdeok-gu, Cheongju, Korea.
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Bruni SG, Patafio FM, Dufton JA, Nolan RL, Islam O. The assessment of anemia from attenuation values of cranial venous drainage on unenhanced computed tomography of the head. Can Assoc Radiol J 2012; 64:46-50. [PMID: 22397828 DOI: 10.1016/j.carj.2011.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 04/09/2011] [Accepted: 08/12/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine if prediction of anemia is possible from quantitative analyses of unenhanced cranial computed tomography (CT) images. METHODS A retrospective chart review revealed 101 patients who had hemoglobin and hematocrit levels obtained within 24 hours of an unenhanced cranial CT. Regions of interest were the place on the torcular Herophili (confluence of sinuses) and the left and right transverse sinuses. Attenuation values were correlated with hemoglobin and hematocrit to investigate any possible relationship. RESULTS Hemoglobin levels were correlated with torcular and transverse sinus attenuation levels. For every 10 Hounsfield unit (HU) increase in torcular attenuation, hemoglobin levels increased by 16.3 g/L (P < .001). When subgroup analysis was performed, by sex, for every 10 HU increase in torcular attenuation, hemoglobin levels increased by 22.6 g/L (P < .001) in men and 8.96 g/L (P < .05) in women. CONCLUSION The attenuation values for venous drainage on unenhanced cranial CT constitute a practical adjunct in the assessment of anemia. Given the number of individuals undergoing CT without blood work, this rapid assessment technique for anemia is a convenient means for narrowing possible diagnoses.
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Affiliation(s)
- Silvio G Bruni
- Undergraduate Medical Education, School of Medicine, Queen's University, Kingston, Ontario, Canada.
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