Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion
Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion
复制标题
非增强计算机断层扫描上脑内血肿的形态学表现可预测血肿的显著扩大
DOI：
10.1161/strokeaha.115.010566
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发表时间：
2015-11-01
期刊：
影响因子：
8.3
通讯作者：
Dowlatshahi, Dar
中科院分区：
文献类型：
--
作者：
Blacquiere, Dylan;Demchuk, Andrew M.;Dowlatshahi, Dar
背景和目的脑出血后血肿扩大与较高的发病率和死亡率相关。计算机断层扫描（CT）血管造影斑点征高度预测扩张，但脑出血的其他形态学特征，如液体水平、密度异质性和边缘不规则性也可预测扩张，特别是在CT血管造影术不容易获得的中心。方法基线非增强CT扫描来自参加使用造影剂团注CT预测脑出血血肿生长和结果的患者（PREDICT）研究中使用先前验证的量表评估是否存在液体水平和密度异质性程度以及边缘不规则性。这些指标的存在和等级与血肿扩张的存在相关，定义由PREDICT研究24小时随访scan.ResultsThree百11例患者被纳入分析。液体水平的存在以及异质性和不规则性的增加与24小时血肿扩大（分别为P=0.021、0.003和0.049）以及绝对血肿大小的增加相关。液体水平具有最高的阳性预测值（50%; 28%-71%），而边缘不规则具有最高的阴性预测值（78%; 71%-85）。非对比度指标具有可比的预测值为扩展时，控制维生素K，抗血小板药物的使用，和基线国立卫生研究院卒中量表的斑点标志，虽然在一个联合的区域下的接收器操作特征曲线模型，斑点标志仍然是最predictor.ConclusionsFluid水平，密度异质性，边缘不规则的非对比CT与血肿扩大在24小时。这些标记物可能有助于预测CT血管造影术不容易获得的情况下的结果，并可能有助于改善CT血管造影斑点征的预测价值。
Background and PurposeHematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available.MethodsBaseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan.ResultsThree hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50%; 28%–71%), whereas margin irregularity had the highest negative predictive value (78%; 71%–85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive.ConclusionsFluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.