Clinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging - A pilot study.
Clinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging - A pilot study.
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DOI：
10.1016/j.jstrokecerebrovasdis.2023.107375
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发表时间：
2023-09
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通讯作者：
Gaby Abou Karam;Hishan Tharmaseelan;Mariam S Aboian;Ajay Malhotra;Emily J Gilmore;G. Falcone;A. D. de Havenon;Kevin N. Sheth;S. Payabvash
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作者：
Gaby Abou Karam;Hishan Tharmaseelan;Mariam S Aboian;Ajay Malhotra;Emily J Gilmore;G. Falcone;A. D. de Havenon;Kevin N. Sheth;S. Payabvash
背景和目的血肿周围水肿（PHE）代表脑出血（ICH）后的继发性脑损伤。然而，除了 PHE 体积之外，ICH 后实质损伤的神经生物学特征尚未得到充分表征。使用体素不相干运动成像 (IVIM)，我们探讨了亚急性 ICH 中 PHE 扩散和（微）灌注指标的临床相关性。材料和方法在幕上 ICH 后 1 至 7 天扫描的 41 名连续患者中，我们确定了手动分段 PHE 内的平均扩散 (D)、伪扩散 (D*) 和灌注分数 (F)。使用单变量和多变量统计数据，我们根据改良Rankin量表（mRS）评估了这些IVIM指标与3个月结果的关系。结果在我们的队列中，患者的平均（±标准差）年龄为68.6±15.6岁，美国国立卫生研究院卒中量表（NIHSS）基线中位（四分位数）为7（3-13），11（27%）名患者预后不良（mRS>3）， 4 人 (10%) 在随访期间死亡。在单变量分析中，入院 NIHSS (p< 0.001)、ICH 体积 (p= 0.019)、ICH+PHE 体积 (p= 0.016) 和 PHE 平均 F (p= 0.005) 与 3 个月 mRS 显着相关。在多变量模型中，入院 NIHSS (p= 0.006) 和 PHE 的平均 F 灌注分数 (p= 0.003) 是 3 个月 mRS 的预测因子。结论 IVIM 灌注分数 (F) 图代表微血管内的血流。我们的初步研究表明，亚急性脑出血中较高的 PHE 微灌注与较差的结果相关。一旦在更大的队列中得到验证，IVIM 指标可以深入了解 ICH 后继发性脑损伤的神经生物学，并识别可能受益于神经保护治疗的高危患者。
Background and purposePerihematomal edema (PHE) represents the secondary brain injury after intracerebral hemorrhage (ICH). However, neurobiological characteristics of post-ICH parenchymal injury other than PHE volume have not been fully characterized. Using intravoxel incoherent motion imaging (IVIM), we explored the clinical correlates of PHE diffusion and (micro)perfusion metrics in subacute ICH.Materials and MethodsIn 41 consecutive patients scanned 1-to-7 days after supratentorial ICH, we determined the mean diffusion (D), pseudo-diffusion (D*), and perfusion fraction (F) within manually segmented PHE. Using univariable and multivariable statistics, we evaluated the relationship of these IVIM metrics with 3-month outcome based on the modified Rankin Scale (mRS).ResultsIn our cohort, the average (± standard deviation) age of patients was 68.6±15.6 years, median (interquartile) baseline National Institute of Health Stroke Scale (NIHSS) was 7 (3–13), 11 (27 %) patients had poor outcomes (mRS>3), and 4 (10 %) deceased during the follow-up period. In univariable analyses, admission NIHSS (p< 0.001), ICH volume (p= 0.019), ICH+PHE volume (p= 0.016), and average F of the PHE (p= 0.005) had significant correlation with 3-month mRS. In multivariable model, the admission NIHSS (p= 0.006) and average F perfusion fraction of the PHE (p= 0.003) were predictors of 3-month mRS.ConclusionThe IVIM perfusion fraction (F) maps represent the blood flow within microvasculature. Our pilot study shows that higher PHE microperfusion in subacute ICH is associated with worse outcomes. Once validated in larger cohorts, IVIM metrics may provide insight into neurobiology of post-ICH secondary brain injury and identify at-risk patients who may benefit from neuroprotective therapy.