Do Imaging Markers of Cerebral Small Vessel Disease Predict Hematoma Volume and Outcome in Acute Intracerebral Hemorrhage?
Do Imaging Markers of Cerebral Small Vessel Disease Predict Hematoma Volume and Outcome in Acute Intracerebral Hemorrhage?
复制标题
脑小血管疾病的成像标记物能否预测急性脑出血的血肿体积和结局？
DOI：
10.4103/aian.aian_183_20
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发表时间：
2021-03
影响因子：
1.7
通讯作者：
Prasad K
中科院分区：
文献类型：
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作者：
Warrier AR;Bhatia R;Garg A;Padma Srivastava MV;Dash D;Tripathi M;Singh MB;Singh V;Vishnubhatla S;Prasad K
脑小血管病（CSVD）标记物与高血压脑出血（ICH）血肿体积和生长的关系尚未得到广泛研究。目的是评估高血压ICH患者的白色高信号病变（WMHL）、微出血（MB）和皮质铁质沉着症（CSS）与血肿体积、血肿扩张（HE）和3个月结局的关系。前瞻性招募了所有连续的急性高血压幕上脑出血急诊。在所有受试者中进行基线和24小时计算机断层扫描（CT）以评估血肿体积，并进行磁共振成像（MRI）以检测CSVD标志物。评估了WMHL（使用Fazekas量表评分）、MB和CSS，并与基线变量和结局进行比较。所有图像均由经验丰富的卒中神经科医生/神经放射科医生进行评估。筛选了157例患者，纳入60例。平均年龄为54.08 ± 11.57岁，47例（78%）为男性。在60例患者中，19例（28.1%）发生HE，31例（51.6%）发生大出血（>30 ml），28例（47.46%）3个月结局较差（mRS 4-6）。单变量分析显示，高分级WMHL与HE程度较高相关[比值比（OR）：2.65，置信区间（CI）：1.48-4.72，P = 0.001]，体积>30 ml的比例较高（OR：7.16，CI：1.09-47.13，P = 0.001），预后差（OR：2.1，CI：0.05-3.27，P = 0.001）。MB与不良结局相关（P = 0.029），但与HE/体积无关。CSS与HE（P = 0.031）、大量出血（P = 0.023）和不良结局（P = 0.021）相关。在多变量模型中，只有WMHL独立预测HE（P = 0.034），出血量>30 ml的比例更高（P = 0.041），预后差（P = 0.042）。MRI中的WMHL可作为高血压ICH中血肿扩大、大量出血和不良结局的预测因子，并可纳入现有的预测模型。
Cerebral small vessel disease (CSVD) markers have not been widely studied in relation to hematoma volume and growth in hypertensive intracerebral hemorrhage (ICH). The objectives to assess the relationship of white matter hyperintense lesions (WMHL), microbleeds (MBs), and cortical siderosis (CSS) with hematoma volume, hematoma expansion (HE), and 3 months outcome in patients with hypertensive ICH. All consecutive acute hypertensive supratentorial ICH presenting to the emergency were prospectively recruited. Baseline and 24 hours computed tomography (CT) to assess hematoma volume and magnetic resonance imaging (MRI) for CSVD markers were performed in all subjects. WMHL (graded using Fazekas's scale), MBs, and CSS were assessed and compared with baseline variables and outcomes. All the images were assessed by an experienced stroke neurologist/neuroradiologist. One hundred and fifty-seven patients were screened and 60 were included. Mean age was 54.08 ± 11.57 years and 47 (78%) were males. Of 60, 19 (28.1%) had HE, 31 (51.6%) had major bleed (>30 ml), and 28 (47.46%) had poor 3 month outcome (mRS 4-6). On univariate analysis, high grade WMHL was associated with greater HE [odds ratio (OR): 2.65, confidence interval (CI) 1.48–4.72, P = 0.001), greater proportion with volume >30 ml (OR: 7.16, CI: 1.09–47.13, P = 0.001) and poor outcome (OR: 2.1, CI: 0.05–3.27, P = 0.001). MBs were associated with poor outcome (P = 0.029) but not with HE/volume. CSS was related to HE (P = 0.031), a large volume bleed (P = 0.023), and poor outcome (P = 0.021). On multivariate model, only WMHL independently predicted HE (P = 0.034), greater proportion with bleed volume >30 ml (P = 0.041), and poor outcome (P = 0.042). WMHL in MRI serves as a predictor of hematoma expansion, a large volume bleed, and poor outcome in hypertensive ICH and may be incorporated into existing prediction models.