ASFNR Recommends NCCT and Nakaguchi Phenotyping for Chronic Subdural Hematoma

Noncontrast CT is primary for chronic subdural hematoma: report max thickness, midline shift, volume (ABC/2), and internal architecture per Nakaguchi (homogeneous, laminar, separated, trabecular). Advanced imaging (dual-energy CT, MRI, ASL) has limited evidence—problem-solving o…

• ASFNR Clinical Practice Committee expert consensus statement.
• For volume estimation, ABC/2 is acceptable; segmentation is more accurate for irregular or multiloculated collections.
• Prospective validation needed before imaging phenotype or advanced biomarkers guide treatment selection.

Automated summary

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