title: Quantitative analysis of computed tomography images and early detection of cerebral edema for pediatric traumatic brain injury patients: retrospective study.
abstract: BACKGROUND
  The purpose of this study was to identify whether the distribution of Hounsfield Unit (HU) values across the intracranial area in computed tomography (CT) images can be used as an effective diagnostic tool for determining the severity of cerebral edema in pediatric traumatic brain injury (TBI) patients.
  
  
  METHODS
  CT images, medical records and radiology reports on 70 pediatric patients were collected. Based on radiology reports and the Marshall classification, the patients were grouped as mild edema patients (n=37) or severe edema patients (n=33). Automated quantitative analysis using unenhanced CT images was applied to eliminate artifacts and identify the difference in HU value distribution across the intracranial area between these groups.
  
  
  RESULTS
  The proportion of pixels with HU=17 to 24 was highly correlated with the existence of severe cerebral edema (P<0.01). This proportion was also able to differentiate patients who developed delayed cerebral edema from mild TBI patients. A significant difference between deceased patients and surviving patients in terms of the HU distribution came from the proportion of pixels with HU=19 to HU=23 (P<0.01).
  
  
  CONCLUSIONS
  The proportion of pixels with an HU value of 17 to 24 in the entire cerebral area of a non-enhanced CT image can be an effective basis for evaluating the severity of cerebral edema. Based on this result, we propose a novel approach for the early detection of severe cerebral edema.
authors.affiliation: Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea. mkhsm@korea.ac.kr.
authors.forename: Hakseung
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea. kdkdkd1@hanmail.net.
authors.forename: Gwang-dong
authors.initials: GD
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. byoon@stanford.edu.
authors.forename: Byung C
authors.initials: BC
authors.lastname: Yoon
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea. keewonkimm.d@gmail.com.
authors.forename: Keewon
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Neurology, Korea University College of Medicine, Seoul, South Korea. nukbj@kumc.or.kr.
authors.forename: Byung-Jo
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Children's Hospital, Seoul, South Korea. choiyounghun@gmail.com.
authors.forename: Young Hun
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, UK. mc141@medschl.cam.ac.uk.
authors.forename: Marek
authors.initials: M
authors.lastname: Czosnyka
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea. keepwiz@gmail.com.
authors.forename: Byung-Mo
authors.initials: BM
authors.lastname: Oh
authors.affiliation: Department of Brain and Cognitive Engineering, Korea University, Anam-dong, Seongbuk-gu, Seoul, 136-713, South Korea. dongjookim@korea.ac.kr.|Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, UK. dongjookim@korea.ac.kr.
authors.forename: Dong-Joo
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D001929:Brain Edema / Q000150:complications / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed