Association Between Hypodensities Detected by Computed Tomography and Hematoma Expansion in Patients With Intracerebral Hemorrhage.
Association Between Hypodensities Detected by Computed Tomography and Hematoma Expansion in Patients With Intracerebral Hemorrhage.
复制标题
脑出血患者计算机断层扫描检测到的低密度影与血肿扩大之间的关联
DOI：
10.1001/jamaneurol.2016.1218
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发表时间：
2016-08-01
期刊：
影响因子：
29
通讯作者：
Goldstein JN
中科院分区：
文献类型：
--
作者：
Boulouis G;Morotti A;Brouwers HB;Charidimou A;Jessel MJ;Auriel E;Pontes-Neto O;Ayres A;Vashkevich A;Schwab KM;Rosand J;Viswanathan A;Gurol ME;Greenberg SM;Goldstein JN
血肿的扩张是急性脑内出血（ICH）的潜在可改变的预测因子（ICH）已建议通过非对比度计算机断层扫描（NCCT）检测到的ICH作为血肿扩张的预测指标。
为了确定低调区域（无论其特定模式如何）是否与ICH患者的血肿扩展有关。
我们分析了784例ICH患者（开发队列； 55.6％的女性），检查了NCCT的发现，并以任何低血压的形式复制了我们对不同患者的发现（复制队列； 52.7％的女性） - 在1994年至2015年之间，连续的ICH患者向三级护理医院呈现NCCT数据进行了回顾性分析。 2015年和2016年1月。
通过2个独立的盲人评估者分析低音。 。
分析中总共有1029名患者。这表明基线时性低（κ= 0.87，用于单变量的分析中，低强度与血肿的扩张相关（163例血肿扩张患者中有86个低音[52.8％]，而没有血肿的621例患者中有136例缺乏症状[21.9％]； P <.001）。 ; p <.001）在多变量模型中；在复制队列中再次证明了低音的独立预测值（优势比，4.37 [95％CI，2.05–9.62]; p <.001）。
在NCCT扫描上检测到的急性ICH内的低元素可能会预测血肿的扩张，而与其他临床和成像预测指标无关。血肿扩张的分层。
Hematoma expansion is a potentially modifiable predictor of poor outcome following an acute intracerebral hemorrhage (ICH). The ability to identify patients with ICH who are likeliest to experience hematoma expansion and therefore likeliest to benefit from expansion-targeted treatments remains an unmet need. Hypodensities within an ICH detected by noncontrast computed tomography (NCCT) have been suggested as a predictor of hematoma expansion. To determine whether hypodense regions, irrespective of their specific patterns, are associated with hematoma expansion in patients with ICH. We analyzed a large cohort of 784 patients with ICH (the development cohort; 55.6% female), examined NCCT findings for any hypodensity, and replicated our findings on a different cohort of patients (the replication cohort; 52.7% female). Baseline and follow-up NCCT data from consecutive patients with ICH presenting to a tertiary care hospital between 1994 and 2015 were retrospectively analyzed. Data analyses were performed between December 2015 and January 2016. Hypodensities were analyzed by 2 independent blinded raters. The association between hypodensities and hematoma expansion (>6 cm3 or 33% of baseline volume) was determined by multivariable logistic regression after controlling for other variables associated with hematoma expansion in univariate analyses with P ≤ .10. A total of 1029 patients were included in the analysis. In the development and replication cohorts, 222 of 784 patients (28.3%) and 99 of 245 patients (40.4%; 321 of 1029 patients [31.2%]), respectively, had NCCT scans that demonstrated hypodensities at baseline (κ = 0.87 for interrater reliability). In univariate analyses, hypodensities were associated with hematoma expansion (86 of 163 patients with hematoma expansion had hypodensities [52.8%], whereas 136 of 621 patients without hematoma expansion had hypodensities [21.9%]; P < .001). The association between hypodensities and hematoma expansion remained significant (odds ratio, 3.42 [95%CI, 2.21–5.31]; P < .001) in a multivariable model; other independent predictors of hematoma expansion were a CT angiography spot sign, a shorter time to CT, warfarin use, and older age. The independent predictive value of hypodensities was again demonstrated in the replication cohort (odds ratio, 4.37 [95%CI, 2.05–9.62]; P < .001). Hypodensities within an acute ICH detected on an NCCT scan may predict hematoma expansion, independent of other clinical and imaging predictors. This novel marker may help clarify the mechanism of hematoma expansion and serve as a useful addition to clinical algorithms for determining the risk of and treatment stratification for hematoma expansion.
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DOI：
10.1159/000346599
发表时间：
2013
期刊：
Cerebrovascular diseases (Basel, Switzerland)
影响因子：
--
作者：
Brouwers HB;Greenberg SM
通讯作者：
Greenberg SM
影响因子：
8.3
作者：
Brouwers, H. Bart;Battey, Thomas W. K.;Romero, Javier M.
通讯作者：
Romero, Javier M.
影响因子：
9.9
作者：
Goldstein, J. N.;Fazen, L. E.;Rosand, J.
通讯作者：
Rosand, J.
脑内出血的计算机断层扫描血管造影仪的系统表征确定血肿膨胀风险最高的患者：点标志评分。
影响因子：
8.3
作者：
Delgado Almandoz JE;Yoo AJ;Stone MJ;Schaefer PW;Goldstein JN;Rosand J;Oleinik A;Lev MH;Gonzalez RG;Romero JM
通讯作者：
Romero JM
影响因子：
29
作者：
Brouwers, H. Bart;Chang, Yuchiao;Falcone, Guido J.;Cai, Xuemei;Ayres, Alison M.;Battey, Thomas W. K.;Vashkevich, Anastasia;McNamara, Kristen A.;Valant, Valerie;Schwab, Kristin;Orzell, Susannah C.;Bresette, Linda M.;Feske, Steven K.;Rost, Natalia S.;Romero, Javier M.;Viswanathan, Anand;Chou, Sherry H. -Y.;Greenberg, Steven M.;Rosand, Jonathan;Goldstein, Joshua N.
通讯作者：
Goldstein, Joshua N.