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Fibrinogen and D-dimer analysis of chronic subdural hematomas and computed tomography findings: a prospective study
Seong-Hyun Park1, Dong-Hun Kang, Jaechan Park
1Department of Neurosurgery, Kyungpook National University Hospital 50, Samduk-2-ga, Jung-gu, Daegu, 700-721, South Korea. nsdoctor@naver.com
Insights
Higher levels of fibrinogen and D-dimer were found in heterogeneous chronic subdural hematomas (CSDHs). These fibrinolytic factors correlate with CSDH evolution and density variations observed on CT scans.
Area of Science:
- Neurosurgery
- Radiology
- Hematology
Background:
- Chronic subdural hematomas (CSDHs) are common in neurosurgical practice.
- CT imaging is crucial for diagnosing CSHDs, revealing heterogeneous or homogeneous densities.
- Fibrinolytic factors may play a role in CSDH pathogenesis and evolution.
Purpose of the Study:
- To investigate the association between fibrinolytic factors (fibrinogen and D-dimer) and CT findings in patients with CSDHs.
- To determine if fibrinolytic factor levels differ between heterogeneous and homogeneous CSDH types.
Main Methods:
- Thirty-one patients with CSDHs were categorized into heterogeneous and homogeneous groups based on CT findings.
- Subdural hematoma samples were collected during surgery.
- Concentrations of fibrinogen and D-dimer were measured in the collected samples.
Main Results:
- Fibrinogen levels were significantly higher in the heterogeneous CSDH group (88.2±121.2 mg/dL) compared to the homogeneous group (<25 mg/dL; p=0.006).
- D-dimer levels were markedly elevated in the heterogeneous group (35,407.9±16,325.5 μg/L) versus the homogeneous group (1476.4±2091.4 μg/L; p<0.001).
- Heterogeneous CSDHs included layering and mixed types, while homogeneous types included high, isodensity, and low density.
Conclusions:
- CSDHs with heterogeneous densities (layering and mixed types) show elevated concentrations of fibrinogen and D-dimer.
- These fibrinolytic factors are implicated in the evolution of CSDHs with heterogeneous CT appearances.
- Findings suggest a link between fibrinolysis and CSDH progression.
Objective:
We investigated the relationship between fibrinolytic factors and computed tomography (CT) findings in patients with chronic subdural hematomas (CSDHs).
Methods:
Thirty-one patients with CSDHs were divided on the basis of CT findings into heterogeneous and homogeneous groups. A sample from the subdural hematoma was obtained at surgery to measure the concentrations of fibrinogen and D-dimer.
Results:
The mean level of fibrinogen in the heterogeneous group, including the layering (n=4) and mixed (n=10) type, was 88.2±121.2 mg/dL, whereas in the homogeneous group, including high density (n=2), isodensity (n=9), and low density (n=6) types, it was <25 mg/dL. The concentration of fibrinogen was significantly higher in the heterogeneous group than in the homogeneous group (p=0.006). The mean level of D-dimer in the heterogeneous group was 35,407.9±16,325.5 μg/L, whereas for the homogeneous group it was 1476.4±2091.4 μg/L. The concentration of D-dimer was significantly higher in the heterogeneous group than in the homogeneous group (p<0.001).
Conclusions:
The layering and mixed types of CSDH exhibited higher concentrations of fibrinogen and D-dimer in subdural hematoma than the homogeneous types. These fibrinolytic factors appear to be associated with evolution in CSDHs with heterogeneous density.
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