Measurement of perihematomal edema in intracerebral hemorrhage.
Measurement of perihematomal edema in intracerebral hemorrhage.
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DOI：
10.1161/strokeaha.114.007565
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发表时间：
2015-04
期刊：
影响因子：
8.3
通讯作者：
Sheth KN
中科院分区：
文献类型：
--
作者：
Urday S;Beslow LA;Goldstein DW;Vashkevich A;Ayres AM;Battey TW;Selim MH;Kimberly WT;Rosand J;Sheth KN
血肿周围水肿（PHE）是脑出血（ICH）继发性损伤的标志。在计算机断层扫描（CT）上测量PHE具有挑战性，并且用于检测PHE的原理尚未完全描述。我们开发了一种系统的方法，用于基于CT的PHE测量。两名独立评估者测量了20名原发性幕上ICH受试者基线和ICH后24小时CT扫描的PHE体积。用边缘检测工具勾画边界，并在检查三个正交平面后进行调整。PHE的描述还应遵循以下原则：（a）比对侧半球的相应区域低密度，（B）出血周围的低密度最高。我们使用组内相关系数（ICC）和Bland-Altman图检查了评价者内和评价者间的可靠性。还使用基于MRI的PHE检测对18名受试者的基于CT的PHE进行了比较。中位PHE体积在基线时为22.7 cc，在ICH后24小时为20.4 cc。评估者之间的PHE测量值无统计学显著差异。PHE的评价者间和评价者内信度非常好。基线和24小时时，评估者间ICC分别为0.98（0.96-1.00）和0.98（0.97-1.00）;评估者内ICC分别为0.99（0.99-1.00）和0.99（0.98-1.00）。Bland-Altman分析显示，基线和24小时PHE测量值的偏倚（−0.5 cc（SD，5.4）和−3.2 cc（SD，5.0））较小，可接受。通过CT和MRI确定的PHE体积相似（23.9 ± 16.9 cc vs. 23.9 ± 16.0 cc，R2 = 0.98，p < 0.0001）。我们的方法在基线和ICH后24小时测量PHE具有出色的可靠性。
Peri-hematomal edema (PHE) is a marker of secondary injury in intracerebral hemorrhage (ICH). PHE measurement on computed tomography (CT) is challenging and the principles used to detect PHE have not been described fully. We developed a systematic approach for CT-based measurement of PHE. Two independent raters measured PHE volumes on baseline and 24-hour post-ICH CT scans of twenty primary supratentorial ICH subjects. Boundaries were outlined with an edge-detection tool and adjusted after inspection of the three orthogonal planes. PHE was delineated with the additional principle that it should be (a) more hypodense than the corresponding area in the contralateral hemisphere and (b) most hypodense immediately surrounding the hemorrhage. We examined intra- and interrater reliability using intraclass correlation coefficients (ICCs) and Bland-Altman plots for interrater consistency. CT-based PHE was also compared using MRI-based PHE detection for eighteen subjects. Median PHE volumes were 22.7 cc at baseline and 20.4 cc at 24-hours post-ICH. There were no statistically significant differences in PHE measurements between raters. Interrater and intrarater reliability for PHE were excellent. At baseline and 24-hours, interrater ICCs were 0.98 (0.96–1.00) and 0.98 (0.97–1.00); intrarater ICCs were 0.99 (0.99–1.00) and 0.99 (0.98–1.00). Bland-Altman analysis showed the bias for PHE measurements at baseline and 24 hours, −0.5 cc (SD, 5.4) and −3.2 cc (SD, 5.0), was acceptably small. PHE volumes determined by CT and MRI were similar (23.9 ± 16.9 cc vs. 23.9 ± 16.0 cc, R2 = 0.98, p < 0.0001). Our method measures PHE with excellent reliability at baseline and 24-hours post-ICH.