Kosin Medical Journal

Original articles

Combined Hounsfield unit measurements of the intracranial cisterns and superior sagittal sinus predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: Junghyun Park; Received April 8, 2026 Accepted May 19, 2026 Published online August 31, 2026; DOI: https://doi.org/10.7180/kmj.26.167 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Delayed cerebral ischemia (DCI) is a major cause of poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We evaluated whether Hounsfield unit (HU) measurements of the intracranial cisterns and superior sagittal sinus (SSS) on admission noncontrast computed tomography (CT) predict DCI.
Methods
We retrospectively analyzed 143 consecutive patients with aSAH treated between January 2021 and December 2023. HU values were measured using region-of-interest analysis in the carotid, interpeduncular, and Sylvian cisterns and the SSS on admission CT. The primary outcome was DCI. Multivariable logistic regression and receiver operating characteristic analyses assessed predictive performance.
Results
DCI developed in 36 patients (25.2%). Patients with DCI had higher cisternal HU (53.6±6.8 vs. 47.9±6.4, p<0.001) and SSS HU (66.3±8.7 vs. 55.3±9.1, p<0.001). Both cisternal HU (odds ratio [OR] per 1 HU increase, 1.07; 95% confidence interval [CI], 1.01–1.13; p=0.02) and SSS HU (OR per 1 HU increase, 1.14; 95% CI, 1.07–1.22; p<0.001) independently predicted DCI, whereas conventional clinical grades did not. The combined HU model showed good discrimination (area under the curve [AUC], 0.82), outperforming SSS HU alone (AUC, 0.78). DCI incidence increased from 9.5% to 40.6% across HU-based risk groups.
Conclusions
Admission noncontrast CT-derived cisternal and SSS HU measurements independently predicted DCI after aSAH. This simple, objective approach may facilitate early risk stratification and targeted monitoring.

Intracranial aneurysms in autosomal dominant polycystic kidney disease: Jung Hyun Park; Kosin Med J. 2024;39(4):281-289. Published online December 6, 2024; DOI: https://doi.org/10.7180/kmj.24.138

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Background
The incidence of intracranial aneurysms (ICA) is high in patients with autosomal dominant polycystic kidney disease (ADPKD). However, little is known regarding the optimal screening and treatment methods for ICA.
Methods
This study investigated the characteristics of ADPKD patients with ICA, analyzing each variable according to whether the ICA ruptured, and examined the outcomes according to the treatment method. Specifically, a retrospective study was conducted on the treatment of ICA patients with ADPKD at a single institution for 10 years, from 2013 to 2022.
Results
The mean age of the 17 enrolled ADPKD patients with ICA was 57.4 years. Surgical and endovascular treatment methods were used in four and 13 patients. Eleven patients had unruptured ICAs, and the remaining six patients had suffered subarachnoid hemorrhage (SAH). Two patients experienced neurological deficits after discharge. All patients with unruptured ICAs were discharged without any complications, although one of them underwent additional treatment 5 years later. Four patients with SAH had known ADPKD at the time of diagnosis (67%). As for the treatment method, 13 patients were treated with coiling. In a comparison of variables between unruptured ICA and SAH patients, the location of the ICA showed a statistically significant difference (p<0.05).
Conclusions
In ADPKD patients, diagnostic screening for the detection of ICA is essential, and with appropriate management, interventional endovascular treatment may be a good treatment option.

Citations

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Hemodialysis elevates postoperative seizure risk without worsening overall outcomes after surgical clipping of unruptured intracranial aneurysms
Mayuko Miyata, Takuma Maeda, Nobuaki Naito, Hiroki Sato, Shiho Sakai, Akio Teranishi, Yushiro Take, Tomomichi Kayahara, Kaima Suzuki, Hiroki Kurita
Neurosurgical Review.2026;[Epub] CrossRef

Diagnostic significance of transcranial Doppler ultrasonography in patients with subarachnoid hemorrhage and cerebral vasospasm: Jung Hyun Park; Kosin Med J. 2024;39(4):265-271. Published online December 2, 2024; DOI: https://doi.org/10.7180/kmj.24.139

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Background
This study investigated the accuracy and usefulness of transcranial Doppler (TCD) ultrasonography as a diagnostic method in patients with subarachnoid hemorrhage (SAH) and cerebral vasospasm.
Methods
This retrospective study collected data from January 2022 to December 2023 at our institution, targeting patients with SAH caused by rupture of a cerebral aneurysm. TCD and brain computed tomographic angiography (CTA) were performed to diagnose cerebral vasospasm. The vessel diameters on CTA at the time of SAH occurrence and CTA 1 to 2 weeks after the occurrence were compared, and TCD was performed on a daily basis from 3 to 14 days after the occurrence of ictus.
Results
Among 152 patients with non-traumatic SAH over a 2-year period, 143 patients with SAH caused by ruptured cerebral aneurysms were enrolled. The mean age was 59.28±13.27 years. The modified Fisher grade was a statistically significant predictor of cerebral vasospasm (p<0.05). In addition, the Hunt-Hess grade also showed statistical significance (p<0.05). TCD showed high accuracy in predicting vasospasm. The sensitivity was 0.93 (95% confidence interval [CI], 0.87–0.97), specificity was 0.89 (95% CI, 0.81–0.96), positive predictive value was 0.92 (95% CI, 0.85–0.96), and negative predictive value was 0.92 (95% CI, 0.84–0.95).
Conclusions
TCD showed high accuracy in predicting the diagnosis of cerebral vasospasm. TCD is considered an essential diagnostic tool in the neurological management of cerebral vasospasm, which is a potentially fatal complication in SAH patients.

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Diagnostic Accuracy of Transcranial Doppler and Electroencephalogram for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta‐Analysis
WenMin Chen, XiaoYun Guo, YaWen Zhang
Journal of Clinical Ultrasound.2026; 54(4): 972. CrossRef

Predicting Factors Associated with Shunt Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: Yong Sook Park, Keum Whang, Yong Pyo Han; Kosin Med J. 2007;22(1):104-113. Published online June 30, 2007

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Usefulness of Acetazolamide-Enhanced Cerebral Perfusion SPECT in Subarachnoid Hemorrhage Patients: Seok Mo Lee, Sang Kyun Bae, Ha Yong Yum, Jae Gon Moon; Kosin Med J. 2000;15(1):65-70.

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