Head Computed Tomography Scan Research Articles

Reduced temporal muscle thickness predicts shorter survival in patients undergoing chronic subdural haematoma drainage.

Chronic subdural haematoma (CSDH) drainage is a common neurosurgical procedure. CSDHs cause excess mortality, which is exacerbated by frailty. Sarcopenia contributes to frailty - its key component, low muscle mass, can be assessed using cross-sectional imaging. We aimed to examine the prognostic role of temporal muscle thickness (TMT) measured from preoperative computed tomography head scans among patients undergoing surgical CSDH drainage. We retrospectively identified all patients who underwent CSDH drainage within 1year of February 2019. We measured their mean TMT from preoperative computed tomography scans, tested the reliability of these measurements, and evaluated their prognostic value for postoperative survival. One hundred and eighty-eight (122, 65% males) patients (median age 78years, IQR 70-85years) were included. Thirty-four (18%) patients died within 2years, and 51 (27%) died at a median follow-up of 39months (IQR 34-42months). Intra- and inter-observer reliability of TMT measurements was good-to-excellent (ICC 0.85-0.97, P<0.05). TMT decreased with age (Pearson's r=-0.38, P<0.001). Females had lower TMT than males (P<0.001). The optimal TMT cut-off values for predicting two-year survival were 4.475mm for males and 3.125mm for females. TMT below these cut-offs was associated with shorter survival in both univariate (HR 3.24, 95% CI 1.85-5.67) and multivariate (HR 1.86, 95% CI 1.02-3.36) analyses adjusted for age, ASA grade and bleed size. The effect of TMT on mortality was not mediated by age. In patients with CSDH, TMT measurements from preoperative imaging were reliable and contained prognostic information supplemental to previously known predictors of poor outcomes.

Intracranial volumetric evaluation in postnatally repaired myelomeningocele infants.

Most myelomeningocele (MMC) cases present with ventriculomegaly or hydrocephalus, yet a comprehensive volumetric assessment of MMC intracranial structures is lacking. This study aimed to provide baseline data on intracranial structural volumes immediately after birth in MMC infants who underwent repair surgeries after birth (postnatal repair). In this retrospective single-center study, we analyzed 52 MMC infants undergoing postnatal repair, utilizing head computed tomography scans at birth for volumetric assessment. Intracranial volume (ICV), lateral ventricles volume (LVV), choroid plexus volume (CPV), and posterior cranial fossa volume (PCFV) were measured. Hydrocephalus was classified into no hydrocephalus, progressive hydrocephalus, and hydrocephalus at birth. Comparative analysis employed the Wilcoxon rank-sum test. Receiver operating characteristic (ROC) analysis discriminated cases with and without ventriculoperitoneal shunt (VPS). The median values were 407.50mL for ICV, 33.18mL for LVV, 0.67mL for CPV, and 21.35mL for PCFV. Thirty-seven cases (71.15%) underwent VPS. ROC analysis revealed an LVV cut-off value of 6.74mL for discriminating cases with and without VPS. Progressive hydrocephalus showed no significant difference in ICV but significantly larger LVV compared to no hydrocephalus. Hydrocephalus at birth demonstrated statistically larger ICV and LVV compared to the other two types. Baseline volumetric data were provided, and volumetric analysis exhibited statistical differences among three hydrocephalus types. These findings enhance our understanding of intracranial volumetric changes in MMC, facilitating more objective assessments of MMC cases.

Emergency physician gender and head computed tomography orders for older adults who have fallen.

Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen. This was a secondary analysis of a prospective observational cohort study conducted in 11 hospital emergency departments (EDs) in Canada and the United States. The primary study enrolled patients who were 65 years and older who presented to the ED after a fall. The analysis evaluated treating physician gender adjusted for multiple clinical variables. Primary analysis used a hierarchical logistic regression model to evaluate the association between treating physician gender and the patient receiving a head CT scan. Secondary analysis reported the adjusted odds ratio (OR) for diagnosing intracranial bleeding by physician gender. There were 3663 patients and 256 physicians included in the primary analysis. In the adjusted analysis, women physicians were no more likely to order a head CT than men (OR 1.26, 95% confidence interval 0.98-1.61). In the secondary analysis of 2294 patients who received a head CT, physician gender was not associated with finding a clinically important intracranial bleed. There was no significant association between physician gender and ordering head CT scans for older emergency patients who had fallen. For patients where CT scans were ordered, there was no significant relationship between physician gender and the diagnosis of clinically important intracranial bleeding.

Exposure to Ionizing Radiation from Initial Brain Computed Tomography for Injuries in the South-West Region of Cameroon

The increasing use of computed tomography (CT) in injury management is a growing concern as ionizing radiation (IR) is associated with cancer-related risks especially in young persons, who are most affected by injuries. This study aimed to assess ionizing radiation exposure from head CT in patients with injuries and to propose CT dose age-specific diagnostic reference levels (DRLs). Data was extracted from two prospectively collected CT registries over a period of 5 years at two community-based university-affiliated hospitals from 2019 to 2024. The linear relationship between CT dose (dose-length product; DLP) and age was assessed using Pearson’s correlation whilst linear regression was used to determine the strength of the relationship. The 75th percentiles and 95% confidence intervals (CIs) of the DLP were determined. Eligible initial head CT scans for patients with injuries were 1,155. There were 685 (59.31%) males (sex ratio of 1.5:1) and overall median age of 33 years (interquartile range: 21 to 46). Road traffic injuries were the source of injury in 1090 individuals (94.37%; 95% CI: 92.88 - 95.63%), followed by falls (50 cases; 4.33%; 95% CI: 3.23 - 5.67%) and assaults (10 cases; 0.87%; 95% CI: 0.42 – 1.59). The median DLP was 1,062 mGy.cm (range: 264 to 1,954 mGy.cm). There was a positive linear relationship between the DLP and the age of the patients (Pearson’s rho = 0.38, p&lt;0.001). DRLs were comparable to international values. Measures to curb the rising incidence of injuries and the continuous implementation of CT optimization techniques will reduce IR exposure.

Initial experience with astate-of-the-art mobile head CT scanner for use in neurointensive care units.

Mobile head computed tomography (CT) scanners can reduce transport-related complications in neurointensive care unit (NICU) patients and decrease the burden on NICU staff; however, the initial investment cost and reduced image quality of early mobile scanners have prevented their widespread clinical use. Here, we report our initial experience with anovel 32-row mobile CT scanner for use in NICUs. Over a2-year period, 107 patients received amobile head CT scan. The technical characteristics of the scanner and the organizational procedures are described in detail. Patient characteristics were retrospectively collected and image quality was subjectively evaluated on aLikert scale ranging from 0 to 5 and compared with astationary CT scanner. Mobile head CT was used for follow-up of intracranial hemorrhage in 51%, routine postoperative imaging in 28%, evaluation of neurological deterioration in 14%, bedside monitoring after external ventricular drain placement in 4%, and follow-up of ischemic stroke in 3% of cases. Diagnostic imaging quality was achieved in all cases, eliminating the need for stationary CT scanning. The overall image quality of mobile CT (median 4points) was inferior to that of conventional stationary CT (median 5points, p < 0.01), but was rated with 4 or 5points in the majority of cases. State-of-the-art mobile CT was found to be easy to use and maneuver and has the potential to expedite the diagnosis of NICU patients and reduce staff workload. Image quality was adequate for common NICU issues.

Estimate and compensate head motion in non-contrast head CT scans using partial angle reconstruction and deep learning.

Patient head motion is a common source of image artifacts in computed tomography (CT) of the head, leading to degraded image quality and potentially incorrect diagnoses. The partial angle reconstruction (PAR) means dividing the CT projection into several consecutive angular segments and reconstructing each segment individually. Although motion estimation and compensation using PAR has been developed and investigated in cardiac CT scans, its potential for reducing motion artifacts in head CT scans remains unexplored. To develop a deep learning (DL) model capable of directly estimating head motion from PAR images of head CT scans and to integrate the estimated motion into an iterative reconstruction process to compensate for the motion. Head motion is considered as a rigid transformation described by six time-variant variables, including the three variables for translation and three variables for rotation. Each motion variable is modeled using a B-spline defined by five control points (CP) along time. We split the full projections from 360° into 25 consecutive PARs and subsequently input them into a convolutional neural network (CNN) that outputs the estimated CPs for each motion variable. The estimated CPs are used to calculate the object motion in each projection, which are incorporated into the forward and backprojection of an iterative reconstruction algorithm to reconstruct the motion-compensated image. The performance of our DL model is evaluated through both simulation and phantom studies. The DL model achieved high accuracy in estimating head motion, as demonstrated in both the simulation study (mean absolute error (MAE) ranging from 0.28 to 0.45mm or degree across different motion variables) and the phantom study (MAE ranging from 0.40 to 0.48mm or degree). The resulting motion-corrected image, , exhibited a significant reduction in motion artifacts when compared to the traditional filtered back-projection reconstructions, which is evidenced both in the simulation study (image MAE drops from 178 33HU to 37 9HU, structural similarity index (SSIM) increases from 0.60 0.06 to 0.98 0.01) and the phantom study (image MAE drops from 117 17HU to 42 19HU, SSIM increases from 0.83 0.04 to 0.98 0.02). We demonstrate that using PAR and our proposed deep learning model enables accurate estimation of patient head motion and effectively reduces motion artifacts in the resulting head CT images.

Long-term sequelae of normocephalic pansynostosis: a rare but insidious entity.

Patients with normocephalic pansynostosis, who have a grossly normal head shape, are often overlooked early in life and present late with elevated intracranial pressure (ICP) requiring timely cranial vault expansion. This study evaluates the long-term clinical outcomes of patients with normocephalic pansynostosis. We retrospectively reviewed patients with a clinical and radiographic diagnosis of primary pansynostosis who underwent vault reconstruction between 2000 and 2023. Clinical and treatment course after craniofacial interventions was followed in patients with normocephaly to assess outcomes. Thirty-five patients with primary pansynostosis were identified, of which eight (23.5%) had normocephaly and underwent initial vault expansion at a mean age of 5.0 ± 2.4years. All eight patients (50.0% male) presented with symptoms of elevated ICP including headaches (50.0%), nausea and vomiting (50.0%), and developmental delay (62.5%) and/or signs of elevated ICP including papilledema (75.0%) and radiologic thumbprinting on head computed tomography scan (87.5%). Three of the four normocephalic patients who had over 7 years of postoperative follow-up developed subjective headaches, vision changes, or learning and behavioral issues in the long-term despite successful vault reconstruction. Our longitudinal experience with this rare but insidious entity demonstrates the importance of timely intervention and frequent postoperative monitoring, which are critical to limiting long-term neurological sequelae. Multidisciplinary care by craniofacial surgery, neurosurgery, ophthalmology, and neuropsychology with follow-up into adolescence are recommended to assess for possible recurrence of elevated ICP secondary to cranio-cerebral disproportion.

248 Isolated Traumatic Subarachnoid Hemorrhage on Head Computed Tomography Scan May Not Be Isolated

INTRODUCTION: Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) is often regarded as a “mild” injury, with reduced need for additional workup. However, tSAH is also a predictor of unfavorable outcomes. Magnetic resonance imaging (MRI) and blood-based biomarkers may improve the diagnosis of concurrent intracranial injury. METHODS: The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury study enrolled patients presenting to ED within 24 hours (h) of TBI who received a clinically-indicated head CT. A subset underwent venipuncture within 24h for plasma glial fibrillary acidic protein (GFAP) analysis, and 2-week research MRI. Participants aged = 17-years with GCS 13-15, isolated tSAH on initial CT, GFAP, and MRI data were analyzed. RESULTS: In 57 patients, median age was 46.0-years [quartile 1 to 3 (Q1-Q3): 34-57] and 53% were male. At ED disposition, 12.3% were discharged home, 61.4% admitted to hospital ward, and 26.3% to intensive care.MRI identified additional traumatic intracranial lesions in 45.6% of patients (1 type: 31.6%; 2 types: 14.0%); of these, 65.4% had axonal injury, 42.3% subdural hematoma, and 23.1% contusion. GFAP levels were higher in patients with additional MRI lesions (median: 630.6-pg/ml, Q1-Q3: [172.4-941.2] vs. 226.4 [105.8-436.1], p = 0.049), and correlated with axonal injury severity (none: median 226.7 [109.6-435.1], traumatic axonal injury: 716.3 [304.0-892.3], diffuse axonal injury: 873.2 [407.2-1321.4], p = 0.034). CONCLUSIONS: Isolated tSAH on head CT is insufficient to rule out additional traumatic injuries in GCS 13-15 TBI. Forty-six percent of patients had additional traumatic lesions on MRI. Plasma GFAP may be an important biomarker for the identification of additional injuries, including axonal injury. Patients with isolated tSAH on CT may require close clinical surveillance and follow-up.

RADIOLOGICAL FEATURES OF THE LOCATION OF CYSTIC FORMATIONS IN THE MAXILLARY SINUS AND THEIR RELATIONSHIP WITH ALVEOLAR BONE PATHOLOGY OF THE UPPER JAW

The aim of the study. To study the features of the location of cystic formations in the maxillary sinus based on CT scans and to determine their relationship with the pathology of the upper jaw teeth.&#x0D; Materials and methods. The study involved the analysis of 552 head computed tomography scans of patients referred for examination by an otolaryngologist or dentist. The total number of individuals examined was 552, comprising 44.7% females and 55.3% males, aged 18-74 years. The investigation was conducted using the NewTom GO device with a measurement range of 155-172 mGy/cm±10%, with an error of ±4.24%. Statistical processing of data was carried out using the STATISTICA v.12.6 software.&#x0D; Results. Out of 552 computed tomography images analyzed, 92 images of individual maxillary sinuses (MS) of 79 patients with single cysts were selected. They were divided into two groups. Group 1 involved patients with cysts on the lower wall of MS (n=76). Group 2 included patients with cysts on other walls (n=16). The assessment of the ratio of 4, 5, 6, 7 tooth roots of the upper jaw to the lower wall of the upper jaw showed that the protrusion frequency in Group 1 was significantly higher (42.1%) compared to Group 2 (18.7%). Meanwhile, the average thickness of the bone over these teeth in Group 2 was significantly greater (3.4 ± 1.09 mm) than in Group 1 (1.9 ± 0.92 mm) (p=0.0003). In both patient groups, the greatest thickness was observed over tooth 4, and the smallest over tooth 7. Additionally, in 33.7% of cases, the cyst was associated with involvement of deep structures of the projecting teeth and the spread of inflammation to the lower wall of MS.&#x0D; Conclusions. Among patients referred by an otolaryngologist or dentist for CT examination to radiologically verify pathological processes in the nasal cavity, paranasal sinuses, and the upper jaw teeth, MS cysts were detected in 19.6% of cases, with 83% of them being localized in its lower parts. In patients with cysts located in the lower parts of MS, the roots protruding into the sinus cavity and a thinner layer of bone over them are more frequently observed compared to those where cysts are located in other areas of MS. In patients with cystic formations in the alveolar recess of MS, radiological signs of pathology of the upper jaw teeth are detected in 34% of cases.

Ocular biometry in rabbits using computed tomography.

To describe a repeatable method of measuring ocular structures and to establish ocular biometry reference ranges in adult domestic rabbits (Oryctolagus cuniculus) without medical history or imaging findings consistent with ophthalmic disease using a 64-slice multidetector computed tomography scanner. In this retrospective and observational anatomic study, 100 eyes from 50 rabbits without medical history or imaging findings consistent with ophthalmic disease who received a head computed tomography scan were selected for measurement of globe length, width, and height using 3D multiplanar reconstruction. Lens width and length, the anteroposterior length of the anterior and vitreous chambers, and attenuation of the lens and vitreous chamber were collected. These parameters were compared against age, sex, weight, body condition, and ear conformation. A reference guide was established, with globe width being the largest dimension (18.03 ± 0.81 mm), followed by height (17.18 ± 0.69 mm) and then length (16.64 ± 0.66 mm). Increased weight was associated with an increase in globe height (p = 2.43 × 10-5 ), length (p = 1.63 × 10-4 ), and width (p = 7.0 × 10-3 ). Increased age was associated with increased lens attenuation (p = 1.28 × 10-7 ) and increased transverse lens width (p = 1.64 × 10-3 ). Inter- and intra-observer agreement was excellent. CT is a reliable modality for measurement of ocular biometry dimensions in rabbits. These reference values can be applied to aid in identifying diseases that affect the dimensions of the ocular structures in rabbits over 18 months of age.

Orbital infarction syndrome following mechanical thrombectomy in internal carotid artery occlusion: a case report

BackgroundOrbital ischemic syndrome is a rare entity. The clinical signs typically demonstrate acute loss of visual acuity, chemosis, proptosis, ptosis, and total ophthalmoparesis. We report a case of a man who suffered an acute internal carotid artery occlusion and developed orbital ischemic syndrome after a mechanical thrombectomy.Case presentationA 57-year-old Vietnamese (Kinh ethnicity) man was brought to the emergency room with complaints of a speech disturbance, facial palsy, and severe weakness of the left arm and leg, which had started 4 hours earlier, after waking up. The National Institutes of Health Stroke Scale 12 (NIHSS 12) revealed the neurological score at admission. A head computed tomography scan showed no intracranial bleeding and an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of 8 on the right brain. Computed tomography angiography showed an occlusion of the right internal carotid artery. After that, a mechanical thrombectomy was performed, and the internal carotid artery was completely reperfused. After 10 hours, he experienced orbital pain, proptosis, ptosis, chemosis, and ophthalmoplegia of the right orbit. He also had acute loss of visual acuity, and fundoscopic examination revealed papilledema, no retinal hemorrhage, and no bruit in orbital auscultation. Intraocular pressure in the right eye was measured at 50.5 mmHg. Computed tomography angiography showed no carotid–cavernous fistula, but slight enlargement of the right medial and lateral rectus muscles. He was treated with steroids and hyperosmolar agents and recovered 7 days later, but had persistent loss of visual acuity in the right eye.ConclusionOrbital ischemic syndrome is a rare complication after mechanical thrombectomy treatment in acute ischemic stroke that can lead to loss of visual acuity.

Isolated Traumatic Subarachnoid Hemorrhage on Head Computed Tomography Scan May Not Be Isolated: A TRACK-TBI Study.

Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) scan is often regarded as a "mild" injury, with reduced need for additional workup. However, tSAH is also a predictor of incomplete recovery and unfavorable outcome. This study aimed to evaluate the characteristics of CT-occult intracranial injuries on brain magnetic resonance imaging (MRI) scan in TBI patients with emergency department (ED) arrival Glasgow Coma Scale (GCS) score 13-15 and isolated tSAH on CT. The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (TRACK-TBI; enrollment years 2014-2019) enrolled participants who presented to the ED and received a clinically-indicated head CT within 24 hours (h) of TBI. A subset of TRACK-TBI participants underwent venipuncture within 24h for plasma glial fibrillary acidic protein (GFAP) analysis, and research MRI at 2-weeks post-injury. In the current study, TRACK-TBI participants aged ≥17 years with ED arrival GCS 13-15, isolated tSAH on initial head CT, plasma GFAP level, and 2-week MRI data were analyzed. In 57 participants, median age was 46.0 years [quartile 1 to 3 (Q1-Q3): 34-57] and 52.6% were male. At ED disposition, 12.3% were discharged home, 61.4% were admitted to hospital ward, and 26.3% to intensive care unit. MRI identified CT-occult traumatic intracranial lesions in 45.6% (26 of 57 participants; 1 additional lesion type: 31.6%; 2 additional lesion types: 14.0%); of these 26 participants with CT-occult intracranial lesions, 65.4% had axonal injury, 42.3% had subdural hematoma, and 23.1% had intracerebral contusion. GFAP levels were higher in participants with CT-occult MRI lesions compared to without (median: 630.6 pg/ml, Q1-Q3: [172.4-941.2] vs. 226.4 [105.8-436.1], p=0.049), and were associated with axonal injury (no: median 226.7 pg/ml [109.6-435.1], yes: 828.6 pg/ml [204.0-1194.3], p=0.009). Our results indicate that isolated tSAH on head CT is often not the sole intracranial traumatic injury in GCS 13-15 TBI. Forty-six percent of patients in our cohort (26 of 57 participants) had additional CT-occult traumatic lesions on MRI. Plasma GFAP may be an important biomarker for the identification of additional CT-occult injuries, including axonal injury. These findings should be interpreted cautiously given our modest sample size and await validation from larger studies.

Introducing fitting models for estimating age-specific dose and effective dose in paediatric patients undergoing head, chest and abdomen-pelvis imaging protocols: a patient study.

Concerns regarding the adverse consequences of radiation have increased due to the expanded application of computed tomography (CT) in medical practice. Certain studies have indicated that the radiation dosage depends on the anatomical region, the imaging technique employed and patient-specific variables. The aim of this study is to present fitting models for the estimation of age-specific dose estimates (ASDE), in the same direction of size-specific dose estimates, and effective doses based on patient age, gender and the type of CT examination used in paediatric head, chest and abdomen-pelvis imaging. A total of 583 paediatric patients were included in the study. Radiometric data were gathered from DICOM files. The patients were categorised into five distinct groups (under 15 years of age), and the effective dose, organ dose and ASDE were computed for the CT examinations involving the head, chest and abdomen-pelvis. Finally, the best fitting models were presented for estimation of ASDE and effective doses based on patient age, gender and the type of examination. The ASDE in head, chest, and abdomen-pelvis CT examinations increases with increasing age. As age increases, the effective dose in head and abdomen-pelvis CT scans decreased. However, for chest scans, the effective dose initially showed a decreasing trend until the first year of life; after that, it increases in correlation with age. Based on the presented fitting model for the ASDE, these CT scan quantities depend on factors such as patient age and the type of CT examination. For the effective dose, the gender was also included in the fitting model. By utilising the information about the scan type, region and age, it becomes feasible to estimate the ASDE and effective dose using the models provided in this study.

Evaluation of risks of cardiovascular disease from radiation exposure linked to computed tomography scans in the UK

Epidemiological studies of patient populations have shown that high doses of radiation increase risks of cardiovascular disease (CVD). Results from a recent meta-analysis of 93 epidemiological studies covering a wide range of doses provided evidence of a causal association between radiation exposure and CVD, and indicated excess relative risk per Gy for maximum dose below 500 mGy or delivered at low dose rates. These doses cover the range of organ doses expected from multiple diagnostic computed tomography (CT) scans. Dose-effect factors for the excess absolute risk of mortality from CVD following radiation exposure were derived from the meta-analysis. The present study uses these factors to estimate excess risks of mortality for various types of CVD, including cerebrovascular disease (CeVD), from CT scans of the body and head, assuming that the meta-analytic factors were accurate and represented a causal relationship. Estimates are based on cumulative doses to the heart and brain from CT scans performed on 105 574 patients on 12 CT scanners over a period of 5½ years. The results suggest that the excess number of deaths from CeVD could be 7 or 26 per 100 000 patients depending whether threshold brain doses of 200 mGy or 50 mGy, respectively are assumed. These results could have implications for head CT scans. However, the results rely on the validity of risk factors derived in the meta-analysis informing this assessment and which include significant uncertainties. Further incidence studies should provide better information on risk factors and dose thresholds, particularly for CeVD following head CT scans.

Grey-to-white matter ratio values in early head CT as a predictor of neurological outcomes in survivors of out-of-hospital cardiac arrest based on severity of hypoxic-ischemic brain injury

Background: Hypoxic-ischemic brain injury (HIBI) is a common complication of out-of-hospital cardiac arrest (OHCA). Objectives: We investigated whether grey-to-white matter ratio (GWR) values, measured using early head computed tomography (HCT), were associated with neurological outcomes based on the severity of HIBI in survivors of OHCA. Methods: This retrospective multicenter study included adult comatose OHCA survivors who underwent an HCT scan within 2 hours after the return of spontaneous circulation. HIBI severity was assessed using the revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) scale (low, moderate, and severe). Poor neurological outcomes were defined as Cerebral Performance Categories 3–5 at 6 months after OHCA. Results: Among 354 patients, 27% were women and 224 (63.3%) had poor neurological outcomes. The distribution of severity was 19.5% low, 47.5% moderate, and 33.1% severe. The area under the receiver operating curves of the GWR values for predicting rCAST severity (low, moderate, and severe) were 0.52, 0.62, and 0.79, respectively. The severe group had significantly higher predictive performance than the moderate group (p=0.02). Multivariate logistic regression analysis revealed a significant association between GWR values and poor neurological outcomes in the moderate group (adjusted odds ratio=0.012, 95% CI 0.0–0.54, p=0.02). Conclusions: In this cohort study, GWR values measured using early HCT demonstrated variations in predicting neurological outcomes based on HIBI severity. Furthermore, GWR in the moderate group was associated with poor neurological outcomes.

Three dimensional convolutional neural network-based automated detection of midline shift in traumatic brain injury cases from head computed tomography scans.

Midline shift (MLS) is a critical indicator of the severity of brain trauma and is even suggestive of changes in intracranial pressure. At present, radiologists have to manually measure the MLS using laborious techniques. Automatic detection of MLS using artificial intelligence can be a cutting-edge solution for emergency health-care personnel to help in prompt diagnosis and treatment. In this study, we sought to determine the accuracy and the prognostic value of our screening tool that automatically detects MLS on computed tomography (CT) images in patients with traumatic brain injuries (TBIs). The study enrolled TBI cases, who presented at the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi. Institutional ethics committee permission was taken before starting the study. The data collection was carried out for over nine months, i.e., from January 2020 to September 2020. The data collection included head CT scans, patient demographics, clinical details as well as radiologist's reports. The radiologist's reports were considered the "gold standard" for evaluating the MLS. A deep learning-based three dimensional (3D) convolutional neural network (CNN) model was developed using 176 head CT scans. The developed 3D CNN model was trained using 156 scans and was tested on 20 head CTs to determine the accuracy and sensitivity of the model. The screening tool was correctly able to detect 7/10 MLS cases and 4/10 non-MLS cases. The model showed an accuracy of 55% with high specificity (70%) and moderate sensitivity of 40%. An automated solution for screening the MLS can prove useful for neurosurgeons. The results are strong evidence that 3D CNN can assist clinicians in screening MLS cases in an emergency setting.

Evaluation of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 Using a Rapid Point of Care Test for Predicting Head Computed Tomography Lesions After Mild Traumatic Brain Injury in a Dutch Multi-Center Cohort.

Mild traumatic brain injury (mTBI) is a common condition seen in emergency departments worldwide. Blood-based biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are recently U.S. Food and Drug Administration-approved for the prediction of intracranial lesions on head computed tomography (CT) scans in mTBI. We evaluated the diagnostic performance of GFAP and UCH-L1 in a Dutch cohort using the i-STAT TBI assay. In a multi-center observational study, we enrolled 253 mTBI patients. Head CT scans were scored using the Marshall classification system. Logistic regression models were used to assess the contribution of biomarkers and clinical parameters to diagnostic performance. Detection of UCH-L1 and GFAP resulted in a sensitivity of 97% and specificity of 19% for CT positivity in mTBI patients, along with a negative predictive value of 95% (88-100%) and a positive predictive value of 27% (21-33%). Combining biomarker testing with loss of consciousness and time to sample increased specificity to 46%. Combined testing of UCH-L1 and GFAP testing resulted in possibly more unnecessary CT scans compared with GFAP testing alone, with only limited increase in sensitivity. This study confirmed high sensitivity of GFAP and UCH-L1 for CT abnormalities in mTBI patients using the i-STAT TBI test. The results support the potential use of GFAP and UCH-L1 as tools for determining the indication for CT scanning in mTBI patients, possibly offering a cost- and time-effective approach to management of patients with mTBI. Prospective studies in larger cohorts are warranted to validate our findings.

Evaluation of overuse of Head Computerized Tomography scan on traumatic brain injury pediatric patients

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among pediatric patients. Head Computerized Tomography (CT) scan has the undoubtedly benefit of diagnosing TBI lesions but is also associated with increased risk of cancer due to radiation. This study was composed of 190 patients evaluated in the emergency setting of a pediatric Brazilian hospital from January 2019 to December 2021. The results of the study demonstrated an increased amount of CT scans in patients with mild TBI during this period. Besides, we noticed that many of these CT scans showed normal results or clinically insignificant findings such as subgaleal hematomas. Knowing the risks related to radiation exposure at such a young age makes us question the validity of the hospital protocol we are following. Also, we believe that a future solution to this issue would be to implement radiation-free complimentary exams such as Magnetic Resonance Imaging (MRI) to our hospital protocol. Emphasizing the importance of justification of procedures and optimization of radiation doses are also crucial to prevent cancer development in pediatric patients.

Exploratory analysis of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 in management of patients with mild neurological symptoms undergoing head computed tomography scan at the emergency department: a pilot study from a Croatian tertiary hospital.

Diagnostic accuracy of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) in identification of intracranial abnormalities detected by computed tomography (CT) in mild traumatic brain injury (mTBI), and in patients with mild neurological symptoms not caused by head trauma but suspected with a neurological disorder, was examined. GFAP and UCH-L1 were determined using the chemiluminescence immunoassays on the Alinity i analyzer (Abbott Laboratories). Significantly higher GFAP (median 53.8 vs 25.7ng/L, P<.001) and UCH-L1 (median 350.9 vs 153.9ng/L, P<.001) were found in mTBI compared to non-head trauma patients. In mTBI diagnostic sensitivity (Se) and specificity (Sp) for the combination of GFAP and UCH-L1 were 100% and 30.9%, respectively, with area under the curve (AUC) 0.655. GFAP alone yielded Se 85.7%, Sp 41.8%, and AUC 0.638, while UCH-L1 yielded Se 57.1%, Sp 56.4%, and AUC 0.568. In non-head trauma patients, the combination of GFAP and UCH-L1 showed Se 100%, Sp 87.9%, and AUC 0.939, while GFAP alone demonstrated Se 100%, Sp 90.9%, and AUC 0.955. If these results are reproduced on a larger sample, GFAP and UCH-L1 may reduce CT use in patients with mild neurological symptoms after systemic causes exclusion and neurologist's evaluation.

Uncertainty-aware deep-learning model for prediction of supratentorial hematoma expansion from admission non-contrast head computed tomography scan

Hematoma expansion (HE) is a modifiable risk factor and a potential treatment target in patients with intracerebral hemorrhage (ICH). We aimed to train and validate deep-learning models for high-confidence prediction of supratentorial ICH expansion, based on admission non-contrast head Computed Tomography (CT). Applying Monte Carlo dropout and entropy of deep-learning model predictions, we estimated the model uncertainty and identified patients at high risk of HE with high confidence. Using the receiver operating characteristics area under the curve (AUC), we compared the deep-learning model prediction performance with multivariable models based on visual markers of HE determined by expert reviewers. We randomly split a multicentric dataset of patients (4-to-1) into training/cross-validation (n = 634) versus test (n = 159) cohorts. We trained and tested separate models for prediction of ≥6 mL and ≥3 mL ICH expansion. The deep-learning models achieved an AUC = 0.81 for high-confidence prediction of HE≥6 mL and AUC = 0.80 for prediction of HE≥3 mL, which were higher than visual maker models AUC = 0.69 for HE≥6 mL (p = 0.036) and AUC = 0.68 for HE≥3 mL (p = 0.043). Our results show that fully automated deep-learning models can identify patients at risk of supratentorial ICH expansion based on admission non-contrast head CT, with high confidence, and more accurately than benchmark visual markers.