Progression of White Matter Injury After Intracerebral Hemorrhage: A Magnetic Resonance Imaging Study
Progression of White Matter Injury After Intracerebral Hemorrhage: A Magnetic Resonance Imaging Study
复制标题
脑出血后白质损伤的进展：磁共振成像研究
DOI：
10.1016/j.wneu.2019.02.089
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发表时间：
2019
影响因子：
2
通讯作者：
Lioutas Vasileios Arsenios
中科院分区：
文献类型：
--
作者：
Wang Deren;Norton Casey;Helenius Johanna;Xu Xiaomeng;Liu Ming;Selim Magdy;Lioutas Vasileios Arsenios
研究背景实验性脑出血（intracerebral hemorrhage，ICH）后可出现脑白质损伤（white matter injury，WTH）。支持的临床数据很少。我们评估的存在，程度，和进展的脑出血患者ICH.MethodsWe进行了一项回顾性研究，从65例连续自发性幕上脑出血谁经历了基线脑磁共振成像（MRI）7天内，脑出血发作和重复MRI后的数据。我们使用Fazekas量表（FZKS）对患者的严重程度进行分级。采用单因素和多因素Logistic回归分析比较了有和无乳腺癌进展（WMIP）患者的临床和影像学特征。在两个半球均观察到WMIP，但更常见于ICH同侧（33% vs. 21%）。平均FZKS总分从基线时的3分（四分位距[IQR]，1-4）增加到重复MRI时的4分（IQR，2-5）（P< 0.0001）。脑叶ICH患者的FZKS评分中位数高于深部ICH患者（中位数，3; IQR，2-4; vs. 1.5，IQR，1-3.25;P= 0.027）。基线实质ICH体积（比值比[OR]，1.067; 95%置信区间[CI]，1.018-1.119;P= 0.007）和基线MRI的心室体积（OR，1.073; 95% CI，1.019-1.130;P= 0.007）是校正后WMIP的预测因子。多因素分析显示WMIP与3个月不良预后独立相关（OR为5.196; 95%CI为1.059-25.483;P= 0.042）。这一新发现可能代表了一个潜在的治疗靶点。未来需要进行更大规模的前瞻性研究来证实我们的发现。
BackgroundWhite matter injury (WMI) has been observed after experimental intracerebral hemorrhage (ICH). The supporting clinical data have been sparse. We assessed the presence, extent, and progression of WMI in patients with ICH.MethodsWe performed a retrospective review of data from 65 consecutive patients with spontaneous supratentorial ICH who had undergone baseline brain magnetic resonance imaging (MRI) within 7 days of ICH onset and repeat MRI afterward. We used the Fazekas scale (FZKS) to grade the severity of WMI. The clinical and imaging characteristics of the patients with and without WMI progression (WMIP) were compared using uni- and multivariate logistic regression analyses.ResultsWe observed WMIP in 23 patients (35.4%). WMIP was noted in both hemispheres but more commonly ipsilateral to the ICH (33% vs. 21%). The mean total FZKS score had increased from 3 (interquartile range [IQR], 1–4) at baseline to 4 (IQR, 2–5) on repeat MRI (P< 0.0001). Patients with lobar ICH had a greater median FZKS score than those with deep ICH (median, 3; IQR, 2–4; vs. 1.5, IQR, 1–3.25;P= 0.027). The baseline parenchymal ICH volume (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.018–1.119;P= 0.007) and ventricular volume on baseline MRI (OR, 1.073; 95% CI, 1.019–1.130;P= 0.007) were predictors of WMIP after adjustment. Multivariate analyses showed an independent association between WMIP and unfavorable 3-month outcomes (OR, 5.196; 95% CI, 1.059–25.483;P= 0.042).ConclusionsWMI will progress over time in patients with ICH, and WMIP has been associated with worse outcomes. This novel finding could represent a potential therapeutic target. Future prospective larger studies are needed to confirm our findings.