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Quantification of Cerebral Edema After Subarachnoid Hemorrhage

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Abstract

Background

Global cerebral edema (GCE) is a manifestation of early brain injury (EBI) after subarachnoid hemorrhage (SAH) and is an independent risk factor for poor outcome. The lack of a quantitative method to measure GCE limits the study of its pathophysiology. The goal of this study is to develop a quantitative surrogate marker that represents GCE after SAH.

Methods

Patients with spontaneous SAH were enrolled into a prospective observational database. Initial CT scans were graded for GCE using established qualitative criteria. Selective sulcal volume (SSV) was defined as total mL of sulcal volumes on axial CT slices above the most cranial section of the lateral ventricles to the last visible section. Using a semiautomatic threshold approach, sulcal regions were traced out with manual adjustments when necessary. The volume of sulci in each slice was calculated and multiplied by the slice thickness and number of slices to calculate the SSV. All volumetric analysis was performed using Medical Image Processing, Analysis and Visualization Version 7.0.1 (MIPAV).

Results

A total of 109 subjects were included in our analysis. Mean selective sulcal volumes (SSV) differed between subjects with and without GCE 4.5 and 21.2 mL (P < 0.001). When separated into quartiles, the odds of qualitative GCE increases as SSV decreases. Compared to the highest SSV quartile, smaller SSV was associated with worse clinical outcomes.

Conclusion

GCE can be quantified using volumetric analysis of SSV measurements on routine CT scans. Smaller SSV on admission is predictive of worse clinical outcomes. SSV may be an important marker of EBI after SAH.

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Author notes

    Authors and Affiliations

    1. Department of Neurosurgery, University of Texas, Houston Health Science Center, Houston, TX, USA

      H. Alex Choi, Suhas S. Bajgur, Wesley H. Jones, Jude P. J. Savarraj, Nancy J. Edwards, Tiffany R. Chang, Georgene W. Hergenroeder, Mark J. Dannenbaum, P. Roc Chen, Arthur L. Day, Dong H. Kim & Kiwon Lee

    2. Department of Neurology, University of Texas, Houston Health Science Center, Houston, TX, USA

      H. Alex Choi, Suhas S. Bajgur, Nancy J. Edwards & Tiffany R. Chang

    3. Department of Neurology, Seoul National University, Seoul, South Korea

      Sang-Bae Ko

    4. Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA

      James C. Grotta

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    1. H. Alex Choi
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    2. Suhas S. Bajgur
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    Corresponding author

    Correspondence to H. Alex Choi.

    Additional information

    H. Alex Choi and Suhas S. Bajgur have contributed equally to this manuscript.

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    Choi, H.A., Bajgur, S.S., Jones, W.H. et al. Quantification of Cerebral Edema After Subarachnoid Hemorrhage. Neurocrit Care 25, 64–70 (2016). https://doi.org/10.1007/s12028-015-0229-3

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    • DOI: https://doi.org/10.1007/s12028-015-0229-3

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