Evaluation of the prognosis of acute subdural hematoma according to the density differences between gray and white matter

OBJECTIVE: Acute subdural hematoma (ASDH) is a common neurological emergency, and its appearance on head-computed tomographic (CT) imaging helps guide clinical treatment. To provide a basis for clinical decision-making, we analyzed that the density difference between the gray and white matter of the CT image is associated with the prognosis of patients with ASDH. METHODS: We analyzed the data of 194 patients who had ASDH as a result of closed traumatic brain injury (TBI) between 2018 and 2021. The patients were subdivided into surgical and non-surgical groups, and the non-surgical group was further subdivided into “diffused [hematoma]” and “non-diffused” groups. The control group's CT scans were normal. The 3D Slicer software was used to quantitatively analyze the density of gray and white matter depicted in the CT images. RESULTS: Imaging evaluation showed that the median difference in density between the gray and white matter on the injured side was 4.12 HU (IQR, 3.91–4.22 HU; p < 0.001) and on the non-injured side was 4.07 HU (IQR, 3.90–4.19 HU; p < 0.001), and the hematoma needs to be surgically removed. The median density difference value of the gray and white matter on the injured side was 3.74 HU (IQR, 3.53–4.01 HU; p < 0.001) and on the non-injured side was 3.71 HU (IQR, 3.69–3.73 HU; p < 0.001), and the hematoma could diffuse in a short time. CONCLUSION: Quantitative analysis of the density differences in the gray and white matter of the CT images can be used to evaluate the clinical prognosis of patients with ASDH.