Leakage sign for acute subdural hematoma in clinical treatment

Abstract

Background Acute subdural hematoma (ASDH) is a serious traumatic disease, and predictive methods for hematoma growth are necessary to decide whether emergent operation is necessary. This study aimed to evaluate the incidence of “leakage” using computed tomography angiography (CTA) in patients with ASDH and to identify its prognostic value. Methods Sixty-seven patients with ASDH were examined using CTA (mean age 64.1 ± 20.6 years; 24 men) by analyzing two serial scans (CTA phase and delayed phase). We defined a positive leakage sign as a > 10% increase in Hounsfield units (HU) in the region of interest. Hematoma expansion was determined using plain CT after 24 h in patients who did not undergo emergent surgery. Results Of the 67 patients, conservative therapy was administered to 35 patients; of these patients, 9 showed hematoma expansion, and 8 of these 9 patients (88.9%) showed positive leakage signs. The sensitivity and specificity of leakage signs to hematoma expansion in the no-surgery group were 88.8% and 76.1%, respectively. All positive leakage signs were found within 4.5 h of injury; patients showing negative leakage signs showed a decreased tendency towards hematoma 24 h after injury. Patients presenting with positive leakage signs had poor outcomes. Conclusions The results indicated that the leakage sign is a sensitive predictor of hematoma expansion and poor outcomes in ASDH. If the hematoma is small but leakage sign-positive, strict observation is necessary and aggressive surgery may improve outcomes.

Preoperative Head CT Assisted Prediction of Acute Encephalocele During Isolated Acute Subdural Hematoma Surgery

“…However, the differences between the observation group (48.00±10.35) and control group (57.26±9.49) were significant (P<0.05). Recently, the imaging marker for hematoma growth has been identified on computed tomographic angiography (CTA), CTA leakage sign may predict hematoma growth and is associated with poor functional outcomes [21], and the blend sign on Computed Tomography is highly specific for predicting hematoma growth in intracerebral hemorrhage patients [22]. Similarly, preoperative most of the observation patients had mixed density of hematoma, we found hematoma volume increased significantly during the operation compared with preoperative CT image.…”

Subdural hematoma expansion in relation to measured mean and peak systolic blood pressure: A retrospective analysis

“…Hematoma expansion was defined as >2 mm increase in size, positive leakage sign, defined as >10 percent Hounsfield unit increase in density of subdural hematoma on CT scan ( 9 ), new midline shift or requiring surgical intervention for a change in status within 24 h of admission. A 2 mm increase in size was chosen to avoid radiologist bias in subdural hematoma measurements.…”