Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging.
Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging.
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DOI：
10.1161/strokeaha.110.590646
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发表时间：
2011-01
期刊：
影响因子：
8.3
通讯作者：
Wijman CA
中科院分区：
文献类型：
--
作者：
Venkatasubramanian C;Mlynash M;Finley-Caulfield A;Eyngorn I;Kalimuthu R;Snider RW;Wijman CA
关于与脑出血（ICH）相关的血肿周围水肿（PHE）的自然史和临床影响的知识有限。我们的目的是确定通过连续 MR 成像测量的 PHE 的时间过程、预测因素和临床意义。原发性幕上 ICH ≥ 5cc 的患者在第一个月内按预先指定的时间间隔接受连续 MRI 检查。在 FLAIR 上测量血肿 (Hv) 和 PHE (Ev) 体积。相对 PHE (rPHE) 定义为 Ev/Hv。入院时和每次 MRI 时均进行神经学评估。 3 个月时进行 Barthel 指数、改良 Rankin 和扩展格拉斯哥结果量表。前瞻性纳入了 27 名接受 88 次 MRI 检查的患者。第一次 MRI 的中值 Hv 和 Ev 分别为 39 和 46cc。中位峰值绝对 Ev 为 88cc。较大的血肿产生较大的绝对 Ev (r2=0.6) 和较小的 rPHE (r2=0.7)。水肿体积增长在前两天最快，但持续到12±3天。在多变量分析中，较高的入院血细胞比容与较长的 PHE 峰值延迟相关 (p=0.06)。较高的入院 PTT 与较高的 rPHE 峰值相关 (p=0.02)。水肿体积增长与 48 小时神经系统状态下降相关（81 Vs 43cc，p=0.03），但与 3 个月功能结果无关。通过 MRI 测量的血肿周围水肿体积在症状出现后的前两天增加最快，并在第 2 周结束时达到峰值。 PHE 量的时间和大小与血液学因素相关。其临床意义值得进一步研究。
Knowledge on natural history and clinical impact of perihematomal edema (PHE) associated with intracerebral hemorrhage (ICH) is limited. We aimed to define the time course, predictors and clinical significance of PHE measured by serial MR imaging. Patients with primary supratentorial ICH of ≥ 5cc underwent serial MRIs at pre-specified intervals during the first month. Hematoma (Hv) and PHE (Ev) volumes were measured on FLAIR. Relative PHE (rPHE) was defined as Ev/Hv. Neurological assessments were performed at admission and with each MRI. Barthel Index, modified Rankin and extended Glasgow outcome scales were done at 3 months. Twenty-seven patients with 88 MRIs were prospectively included. Median Hv and Ev on the first MRI were 39 and 46cc. Median peak absolute Ev was 88cc. Larger hematomas produced larger absolute Ev (r2=0.6) and smaller rPHE (r2 =0.7). Edema volume growth was fastest in the first two days, but continued until 12±3 days. In multivariate analysis, a higher admission hematocrit was associated with a greater delay in peak PHE (p=0.06). Higher admission PTT was associated with higher peak rPHE (p=0.02). Edema volume growth correlated with a decline in neurologic status at 48 hours (81 Vs 43cc, p=0.03), but not with 3-month functional outcome. Perihematomal edema volume measured by MRI increases most rapidly in the first two days after symptom onset and peaks towards the end of the 2nd week. The timing and magnitude of PHE volume is associated with hematological factors. Its clinical significance deserves further study.