Automated Measurement of Cerebral Atrophy and Outcome in Endovascular Thrombectomy
Automated Measurement of Cerebral Atrophy and Outcome in Endovascular Thrombectomy
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DOI：
10.1161/strokeaha.119.027120
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发表时间：
2019-12-01
期刊：
影响因子：
8.3
通讯作者：
Barber, P. Alan
中科院分区：
文献类型：
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作者：
Diprose, William K.;Diprose, James P.;Barber, P. Alan
背景和目的-确定血管内血栓切除术（EVT）后预后不良可能性更大的缺血性卒中患者的方法可能会改善患者、家属和医生之间的共同治疗决策。我们使用了一个客观的，自动化的方法来衡量脑萎缩，并调查这是否与EVT patients. Methods-ConcretiveEVT患者从一个单中心注册的结果进行了研究。CT脑扫描用经验证的U-Net和Hounsfield单位阈值的组合进行分割。颅内脑脊液（CSF）体积被用作脑萎缩的标志物，并计算为总颅内体积的比例。主要结果是功能独立性，定义为3个月的改良兰金量表评分为0 - 2分。204例（56.7%）患者实现了功能独立。平均+/- SD CSF体积为颅内总体积的9.0 +/- 4.7%。多变量回归分析表明，脑脊液容量增加与功能独立性降低相关（CSF体积每增加5%，OR=0.65; 95% CI，0.48-0.89; P=0.007）和3个月改良兰金量表评分较高（普通OR，CSF体积每增加5%为1.59; 95%CI，1.05-2.41; P=0.03）.结论：通过自动测量颅内CSF体积确定的脑萎缩与接受EVT的患者的功能结局相关。如果在未来的研究中得到验证，这种简单，客观和自动化的成像标记物可能会被纳入决策支持工具，以改善共享的治疗决策。
Background and Purpose-Methods of identifying ischemic stroke patients with a greater probability of poor outcome following endovascular thrombectomy (EVT) might improve shared treatment decision-making between patients, families, and physicians. We used an objective, automated method to measure cerebral atrophy and investigated whether this was associated with outcome in EVT patients.Methods-Consecutive EVT patients from a single-center registry were studied. CT brain scans were segmented with a combination of a validated U-Net and Hounsfield unit thresholding. Intracranial cerebrospinal fluid (CSF) volume was used as a marker of cerebral atrophy and calculated as a proportion of total intracranial volume. The primary outcome was functional independence, defined as a 3-month modified Rankin Scale score of 0 to 2.Results-Three-hundred sixty EVT patients were included. Functional independence was achieved in 204 (56.7%) patients. The mean +/- SD CSF volume was 9.0 +/- 4.7% of total intracranial volume. Multivariable regression demonstrated that increasing CSF volume was associated with reduced functional independence (OR=0.65 per 5% increase in CSF volume; 95% CI, 0.48-0.89; P=0.007) and higher 3-month modified Rankin Scale scores (common OR, 1.59 per 5% increase in CSF volume; 95% CI, 1.05-2.41; P=0.03).Conclusions-Cerebral atrophy determined by automated measurement of intracranial CSF volume is associated with functional outcome in patients undergoing EVT. If validated in future studies, this simple, objective, and automated imaging marker could potentially be incorporated into decision-support tools to improve shared treatment decision-making.