Poor correlation between perihematomal MRI hyperintensity and brain swelling after intracerebral hemorrhage.
Poor correlation between perihematomal MRI hyperintensity and brain swelling after intracerebral hemorrhage.
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DOI：
10.1007/s12028-011-9578-8
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发表时间：
2011-12
影响因子：
3.5
通讯作者：
Powers, William J.
中科院分区：
文献类型：
--
作者：
Zazulia, Allyson R.;Videen, Tom O.;Diringer, Michael N.;Powers, William J.
血肿周围高信号常被解释为ICH后的脑水肿，但这种解释的准确性尚不清楚。因此，我们研究了脑出血后第一周内PHH变化与半球脑体积变化之间的关系，作为衡量水肿的指标。对15名年龄为66±13岁、基线血肿大小为13.1 mL（范围3-43）的个体在自发性幕上ICH后1.0±0.5、2.6±0.9和6.5±1.0天进行了前瞻性MRI研究。大脑半球体积的变化进行了评估，使用脑边界移动积分MPPT。在T2加权像上测量血肿和PHH体积。相对于10名正常对照（−0.9±4.1 mL，p=0.02），第一次和第二次扫描之间的脑体积增加较小但具有统计学显著性（6.3±8.0 mL，0.6±0.7%），并在第三次扫描时恢复至基线水平（1.5±9.5 mL vs.对照组0.9±4.0 mL，p=0.85）。在扫描2或扫描3时，两个半球之间的体积变化没有显著差异。在扫描2（p=0.04）和扫描3（p=0.004）时，PHH的变化显著大于同侧半球体积的变化，且与同侧半球体积的变化相关性较差。NIHSS的变化与PHH、同侧或扫描2或扫描3时的总脑体积的变化之间无显著相关性（均p> 0.05）。在小到中等大小血肿的患者中，PHH的变化是ICH后第一周脑水肿的不良指标。发生了轻微的双半球脑肿胀，但临床意义不大。
The perihematomal hyperintensity is commonly interpreted to represent cerebral edema following ICH, but the accuracy of this interpretation is unknown. We therefore investigated the relationship between changes in PHH and changes in hemispheric brain volume as a measure of edema during the first week after ICH. Fifteen individuals aged 66±13 with baseline hematoma size of 13.1 mL (range 3–43) were prospectively studied with sequential MRI 1.0±0.5, 2.6±0.9, and 6.5±1.0 days after spontaneous supratentorial ICH. Changes in hemispheric brain volume were assessed on MPRAGE using the Brain-Boundary Shift Integral. Hematoma and PHH volumes were measured on T2-weighted images. Brain volume increased a small but statistically significant amount (6.3±8.0 mL, 0.6±0.7%) between the first and second scans relative to 10 normal controls (−0.9±4.1 mL, p=0.02) and returned toward baseline at the third scan (1.5±9.5 mL vs. controls 0.9±4.0 mL, p=0.85). There were no significant differences in the volume changes between the two hemispheres at scan 2 or scan 3. At both scan 2 (p=0.04) and scan 3 (p=0.004), the change in PHH was significantly greater than and poorly correlated with the change in ipsilateral hemispheric volume. There were no significant correlations between change in NIHSS and change in PHH, ipsilateral, or total brain volume at scan 2 or scan 3 (all p> 0.05). In patients with small-to-moderate-sized hematomas, change in PHH was a poor measure of brain edema in the first week following ICH. A small degree of bihemispheric brain swelling occurred but was of little clinical significance.
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