RADAR - Radiomics on aSDH: predicting outcome with surface area.

Background: Acute subdural hematoma is a critical condition, leading to significant morbidity and mortality. Despite advancements in surgical techniques, a portion of patients only show limited clinical improvement post-evacuation. Surgical intervention decisions are critically important, as they can either improve or worsen a patient's condition. Radiomics offers significant potential by extracting complex patterns from digital medical images and transforming them into high-dimensional data that reflect the underlying pathophysiology. By integrating Radiomics with individual patient characteristics, we can develop decision support models. This study aims to analyze radiomic parameters of aSDH to determine whether they support the decision to proceed with urgent surgery or opt for a conservative approach. We hypothesized that surface area could be a significant predictor of neurological outcome such as maintaining independent mobility (mRS ≥ 3) and survival rates.

Methods: This retrospective study involved radiomic analysis according to neurological outcome and survival. Radiomic parameters were measured using 3D Slicer software. Statistical analyses explored correlations, employing AUC-analysis and Kaplan-Meier survival.

Results: Our findings revealed significant correlations between hematoma and surface area with poorer neurological prognosis. Further subgroup analysis showed surface area as a significant predictor for poorer outcomes in patients undergoing craniotomy (p = 0.006 in univariant- and p = 0.020 in multivariant analysis). In the total cohort, among conservatively managed and craniotomy subgroups, survival analysis highlighted an advantageous survival for patients exhibiting smaller surface areas (< 339.50 cm).

Conclusions: Especially in craniotomy patients, surface area emerged as a possible predictor for neurological outcome and survival.