Rate of Contrast Extravasation on Computed Tomographic Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage
Rate of Contrast Extravasation on Computed Tomographic Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage
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DOI：
10.1161/strokeaha.115.009659
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发表时间：
2015-09-01
期刊：
影响因子：
8.3
通讯作者：
Romero, Javier M.
中科院分区：
文献类型：
--
作者：
Brouwers, H. Bart;Battey, Thomas W. K.;Romero, Javier M.
背景和目的的原发性脑内出血，计算出层析造影术（CTA）后的对比度渗出的存在，称为斑点标志，可预测血肿的扩张和死亡率。由于尚未完全了解点标志的生物基础基础，因此我们研究了可能反映出出血率的对比度是否可以预测超出现场符号的简单存在。首先CTA随后包括90秒延迟的cont对比后CT（延迟CTA）。 2名盲目的读者对CTA进行了审查，以进行点标志。使用半小局的软件测量了第一次通用和延迟的CTA和脑出血体积上的点标志量。计算并测试了使用单次和多变量逻辑回归的血肿扩张和死亡率的关联。包括一百六十二名患者，其中48名（30％）的患者具有> = 1个点标志。首先CTA的中值点标志体积为0.04 mL，延迟CTA的斑点体积为0.4毫升。在扩展器中，中值的溢出速率为0.23 ml/min，在非膨胀器中为0.07 ml/min，在非膨胀器中为0.30 ml/min。在医院死亡的患者中，渗出率也明显更高：0.27 mL/min，而0.04 mL/min。在多变量分析中，渗出率与院内死亡率独立相关（优势比，1.09 [95％置信区间，1.04-1.18]，p = 0.004），90天死亡率（优势比，1.15 [95％置信区间[95％置信区间，1.08-1.27]; p = 0.0004）和血肿的扩张间隔，1.01-1.08];我们的结果支持以下假设：斑点标志直接测量急性脑内出血中的活性出血。
Background and Purpose-In primary intracerebral hemorrhage, the presence of contrast extravasation after computed tomographic angiography (CTA), termed the spot sign, predicts hematoma expansion and mortality. Because the biological underpinnings of the spot sign are not fully understood, we investigated whether the rate of contrast extravasation, which may reflect the rate of bleeding, predicts expansion and mortality beyond the simple presence of the spot sign.Methods-Consecutive intracerebral hemorrhage patients with first-pass CTA followed by a 90-second delayed postcontrast CT (delayed CTA) were included. CTAs were reviewed for spot sign presence by 2 blinded readers. Spot sign volumes on first-pass and delayed CTA and intracerebral hemorrhage volumes were measured using semiautomated software. Extravasation rates were calculated and tested for association with hematoma expansion and mortality using uni- and multivariable logistic regressions.Results-One hundred and sixty-two patients were included, 48 (30%) of whom had >= 1 spot sign. Median spot sign volume was 0.04 mL on first-pass CTA and 0.4 mL on delayed CTA. Median extravasation rate was 0.23 mL/min overall and 0.30 mL/min among expanders versus 0.07 mL/min in nonexpanders. Extravasation rates were also significantly higher in patients who died in hospital: 0.27 mL/min versus 0.04 mL/min. In multivariable analysis, the extravasation rate was independently associated with in-hospital mortality (odds ratio, 1.09 [95% confidence interval, 1.04-1.18], P=0.004), 90-day mortality (odds ratio, 1.15 [95% confidence interval, 1.08-1.27]; P=0.0004), and hematoma expansion (odds ratio, 1.03 [95% confidence interval, 1.01-1.08]; P=0.047).Conclusions-Contrast extravasation rate, or spot sign growth, further refines the ability to predict hematoma expansion and mortality. Our results support the hypothesis that the spot sign directly measures active bleeding in acute intracerebral hemorrhage.