Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage
Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage
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DOI：
10.1212/01.wnl.0000257087.22852.21
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发表时间：
2007-03-20
期刊：
影响因子：
9.9
通讯作者：
Rosand, J.
中科院分区：
文献类型：
--
作者：
Goldstein, J. N.;Fazen, L. E.;Rosand, J.
背景：已知在症状发作3小时内出现急性脑内出血（ICH）的患者已知增加的风险增加。但是，在此时间范围内，只有少数人到达。因此，需要进行扩展风险的替代标记。目的：检查在介绍时对CT血管造影（CTA）的对比度是否可以预测随后的血肿扩张。方法：在数据库中前瞻性地捕获了向城市三级护理医院介绍的连续主要ICH患者。我们回顾了所有接受CTA的患者的图像，并在48小时内至少进行了一次CT扫描。结果：104名患者可用完整的数据。在56％的患者中存在CTA时的对比度渗出，并且与血肿扩张的风险增加有关（22％vs 2％，P = 0.003）。在3小时内接受基线CTA的患者更有可能随后扩张（27％，后来出现的患者为13％，p = 0.1）。然而，经过多变量分析，对比度的外渗是血肿扩张的唯一重要预测指标（OR 18，95％CI 2.1至162）。这种效果与演示时间无关。结论：对比度渗出与血肿的扩张独立相关。传统上，症状发作后的最初几个小时内出现的患者被认为是最高膨胀风险的患者。但是，对于稍后出现的人来说，对比的存在可能是指导旨在降低这种风险的疗法的有用标记。
Background: Patients with acute intracerebral hemorrhage ( ICH) presenting within 3 hours of symptom onset are known to be at increased risk of expansion. However, only a minority arrive within this time frame. Therefore, alternative markers for expansion risk are needed. Objective: To examine whether contrast extravasation on CT angiography ( CTA) at presentation predicts subsequent hematoma expansion. Methods: Consecutive patients with primary ICH presenting to an urban tertiary care hospital were prospectively captured in a database. We retrospectively reviewed images for all patients receiving a CTA and at least one further CT scan within 48 hours. Results: Complete data were available for 104 patients. Contrast extravasation at the time of CTA was present in 56% of patients, and associated with an increased risk of hematoma expansion ( 22% vs 2%, p = 0.003). Patients who received a baseline CTA within 3 hours were more likely to have subsequent expansion ( 27%, vs 13% for those presenting later, p = 0.1). However, after multivariable analysis, contrast extravasation was the only significant predictor of hematoma expansion ( OR 18, 95% CI 2.1 to 162). This effect was independent of time to presentation. Conclusions: Contrast extravasation is independently associated with hematoma expansion. Patients presenting within the first few hours after symptom onset have traditionally been considered those at highest risk of expansion. However, for those presenting later, the presence of contrast may be a useful marker to guide therapies aimed at decreasing this risk.