Radiological Investigation of Spontaneous Intracerebral Hemorrhage Systematic Review and Trinational Survey
Radiological Investigation of Spontaneous Intracerebral Hemorrhage Systematic Review and Trinational Survey
复制标题
DOI：
10.1161/strokeaha.109.572495
复制
发表时间：
2010-04-01
期刊：
影响因子：
8.3
通讯作者：
Salman, Rustam Al-Shahi
中科院分区：
文献类型：
--
作者：
Cordonnier, Charlotte;Klijn, Catharina J. M.;Salman, Rustam Al-Shahi
背景和目的——是否、如何以及何时对自发性（非创伤性）脑出血（ICH）进行进一步的放射学检查并不总是很清楚。方法——我们系统地回顾了 Ovid MEDLINE 和 EMBASE 数据库，以研究 ICH 原因的放射学检查的诊断效用。我们向英国、荷兰和法国的神经科医生、中风专家、神经外科医生和神经放射科医生发送了一份结构化调查，以评估他们是否、如何以及何时调查幕上 ICH。结果 - 这项系统评价发现了 20 项相关研究（包括 1933 名患者），这些研究要么量化放射学检查/成像策略的产量 (n = 15)，要么比较 2 种成像技术 (n = 5)。六百九十二 (49%) 名医生对调查做出了回应。进一步的调查将由以下人员进行： 99% 的受访者为患有脑叶或深部脑出血的较年轻（38 至 43 岁）、血压正常的成年人； 76%，对于年龄较大（72 至 83 岁）、血压正常、患有深部 ICH 的成年人；患有深部脑出血和卒中前高血压的老年人为 31%。较年轻的患者年龄对进一步调查 ICH 的决定影响最大（比值比 = 16；95% 置信区间，13 至 20），其次是没有卒中前期高血压（比值比 = 5；95% 置信区间，4 至 6）和脑叶 ICH 位置（比值比 = 2；95% 置信区间，1 至 2）。 ICH 的原因可能会导致当前临床实践中对何时、如何以及哪些患者进行调查方面观察到的变化。需要进行比较不同类型诊断策略的研究。 （中风。2010；41：685-690。）
Background and Purpose-It is not always clear whether, how, and when to undertake further radiological investigation of spontaneous (nontraumatic) intracerebral hemorrhage (ICH).Methods-We systematically reviewed Ovid MEDLINE and EMBASE databases for studies of the diagnostic utility of radiological investigations of the cause(s) of ICH. We sent a structured survey to neurologists, stroke specialists, neurosurgeons, and neuroradiologists in the United Kingdom, the Netherlands, and France to assess whether, how, and when they would investigate supratentorial ICH.Results-This systematic review detected 20 relevant studies (including 1933 patients), which either quantified the yield of a radiological investigation/imaging strategy (n=15) or compared 2 imaging techniques (n=5). Six hundred ninety-two (49%) physicians responded to the survey. Further investigation would have been undertaken by the following: 99% of respondents, for younger (38 to 43 years), normotensive adults with lobar or deep ICH; 76%, for older (age 72 to 83 years), normotensive adults with deep ICH; and 31%, for older adults with deep ICH and prestroke hypertension. Younger patient age was the strongest influence on the decision to further investigate ICH (odds ratio=16; 95% confidence interval, 13 to 20), followed by the absence of prestroke hypertension (odds ratio=5; 95% confidence interval, 4 to 6) and lobar ICH location (odds ratio=2; 95% confidence interval, 1 to 2).Conclusions-The paucity of studies on the diagnostic utility of imaging investigations of the cause(s) of ICH may contribute to the variation observed in when and how and which patients are investigated in current clinical practice. Studies comparing different types of diagnostic strategies are required. (Stroke. 2010;41:685-690.)