动脉瘤性蛛网膜下腔出血:对血液分布模式进行体积量化,准确预测动脉瘤破裂位置

IF 0.7 4区 医学 Q4 NEUROSCIENCES Neurocirugia Pub Date : 2024-05-01 DOI:10.1016/j.neucir.2023.11.003
Alejandra Mosteiro , Diego Culebras , Alberto Vargas Solano , Javier Luis Moreno Negrete , Antonio López-Rueda , Laura Llull , Daniel Santana , Leire Pedrosa , Sergio Amaro , Ramón Torné , Joaquim Enseñat
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引用次数: 0

摘要

背景在自发性蛛网膜下腔出血(SAH)中,准确确定出血源对于指导治疗至关重要。传统上,出血模式被用来预测动脉瘤的位置。在此,我们测试了一种基于软件的工具,该工具可量化颅内血量,并根据区域分布进行分层,从而预测动脉瘤破裂的位置。方法2012-2018年间,一个三级中心连续收治了一系列发病72小时内、患有单个颅内动脉瘤的SAH患者。对初始非对比 CT 采用基于相对密度增加的半自动化血液量化方法。结果68名患者被纳入分析。血液分布与动脉瘤位置之间存在密切联系(p < 0.001)。特别是ACom与大脑半球间裂隙(p <0.001),MCA与同侧大脑半球(p <0.001),ICA与同侧大脑半球和大脑周围蝶窦(p <0.001),PCom与大脑半球、大脑周围和脑室内(p = 0.019),PICA与大脑周围和脑室内(p <0.001)。结论区域自动容积测量法似乎是量化和描述蛛网膜下腔内血液分布的可靠而客观的工具。该工具可准确预测动脉瘤破裂的位置;在急诊环境中,当达到快速和简便的目的时,可考虑使用该工具。
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Aneurysmal subarachnoid haemorrhage: Volumetric quantification of the blood distribution pattern to accurately predict the ruptured aneurysm location

Background

In spontaneous subarachnoid haemorrhage (SAH) accurate determination of the bleeding source is paramount to guide treatment. Traditionally, the bleeding pattern has been used to predict the aneurysm location. Here, we have tested a software-based tool, which quantifies the volume of intracranial blood and stratifies it according to the regional distribution, to predict the location of the ruptured aneurysm.

Methods

A consecutive series of SAH patients admitted to a single tertiary centre between 2012–2018, within 72 h of onset, harbouring a single intracranial aneurysm. A semi-automatized method of blood quantification, based on the relative density increase, was applied to initial non-contrast CTs. Five regions were used to define the bleeding patterns and to correlate them with aneurysm location: perimesencephalic, interhemispheric, right/left hemisphere and intraventricular.

Results

68 patients were included for analysis. There was a strong association between the distribution of blood and the aneurysm location (p < 0.001). In particular: ACom and interhemispheric fissure (p < 0.001), MCA and ipsilateral hemisphere (p < 0.001), ICA and ipsilateral hemisphere and perimesencephalic cisterns (p < 0.001), PCom and hemispheric, perimesencephalic and intraventricular (p = 0.019), and PICA and perimesencephalic and intraventricular (p < 0.001). The internal diagnostic value was high (AUROC ≥ 0.900) for these locations.

Conclusion

Regional automatised volumetry seems a reliable and objective tool to quantify and describe the distribution of blood within the subarachnoid spaces. This tool accurately predicts the location of the ruptured aneurysm; its use may be prospectively considered in the emergency setting when speed and simplicity are attained.

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来源期刊
Neurocirugia
Neurocirugia 医学-神经科学
CiteScore
1.30
自引率
0.00%
发文量
67
审稿时长
60 days
期刊介绍: Neurocirugía is the official Journal of the Spanish Society of Neurosurgery (SENEC). It is published every 2 months (6 issues per year). Neurocirugía will consider for publication, original clinical and experimental scientific works associated with neurosurgery and other related neurological sciences. All manuscripts are submitted for review by experts in the field (peer review) and are carried out anonymously (double blind). The Journal accepts works written in Spanish or English.
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