急性脑出血颅内室室的测量:来自高血压卒中快速干预试验的数据(右2)。

IF 4.4 1区 医学 Q1 CLINICAL NEUROLOGY Stroke and Vascular Neurology Pub Date : 2023-04-01 DOI:10.1136/svn-2021-001375
Kailash Krishnan, Zhe Kang Law, Lisa J Woodhouse, Rob A Dineen, Nikola Sprigg, Joanna M Wardlaw, Philip M Bath
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引用次数: 0

摘要

背景和目的:颅内出血量(ICHV)对预后有重要意义,但不能解释颅内体积(ICV)和脑实质体积(CPV)。我们使用计算机断层扫描评估急性脑出血患者颅内室室的测量,以及ICHV/ICV和ICHV/CPV是否预测功能结局。我们还评估了脑池淡化、中线移位、陈旧性梗死、白质变和脑萎缩是否与预后相关。方法:对高血压性卒中2期快速干预试验133例参与者的资料进行分析。测量包括ICHV(使用ABC/2)和ICV (XYZ/2)(由独立观察员);ICHV、ICV和CPV(半自动分割,SAS);萎缩(尾间距离,ICD, Sylvian裂隙比,SFR);中线移位;白质变和脑池淡化(目测)。评估这些措施对第4天死亡和第90天功能不良结局的影响(修正Rankin量表,mRS >3)。结果:XYZ和SAS之间的ICV有显著差异:平均(SD)为1357 (219)vs 1420(196),平均差(MD)为62 mL(结论:颅内间隔测量和视觉估计是可重复的。脑出血和脑脊液电位调整后的脑脊液电位可用于预测急性脑卒中患者的预后。中线移位和蓄水池消失的存在可以预测结果,但其机制需要在更大规模的研究中得到验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2).

Background and purpose: Intracerebral haemorrhage volume (ICHV) is prognostically important but does not account for intracranial volume (ICV) and cerebral parenchymal volume (CPV). We assessed measures of intracranial compartments in acute ICH using computerised tomography scans and whether ICHV/ICV and ICHV/CPV predict functional outcomes. We also assessed if cistern effacement, midline shift, old infarcts, leukoaraiosis and brain atrophy were associated with outcomes.

Methods: Data from 133 participants from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial trial were analysed. Measures included ICHV (using ABC/2) and ICV (XYZ/2) (by independent observers); ICHV, ICV and CPV (semiautomated segmentation, SAS); atrophy (intercaudate distance, ICD, Sylvian fissure ratio, SFR); midline shift; leukoaraiosis and cistern effacement (visual assessment). The effects of these measures on death at day 4 and poor functional outcome at day 90 (modified Rankin scale, mRS of >3) was assessed.

Results: ICV was significantly different between XYZ and SAS: mean (SD) of 1357 (219) vs 1420 (196), mean difference (MD) 62 mL (p<0.001). There was no significant difference in ICHV between ABC/2 and SAS. There was very good agreement for ICV measured by SAS, CPV, ICD, SFR, leukoaraiosis and cistern score (all interclass correlations, n=10: interobserver 0.72-0.99, intraobserver 0.73-1.00). ICHV/ICV and ICHV/CPV were significantly associated with mRS at day 90, death at day 4 and acute neurological deterioration (all p<0.05), similar to ICHV. Midline shift and cistern effacement at baseline were associated with poor functional outcome but old infarcts, leukoaraiosis and brain atrophy were not.

Conclusions: Intracranial compartment measures and visual estimates are reproducible. ICHV adjusted for ICH and CPV could be useful to prognosticate in acute stroke. The presence of midline shift and cistern effacement may predict outcome but the mechanisms need validation in larger studies.

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来源期刊
Stroke and Vascular Neurology
Stroke and Vascular Neurology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
11.20
自引率
1.70%
发文量
63
审稿时长
15 weeks
期刊介绍: Stroke and Vascular Neurology (SVN) is the official journal of the Chinese Stroke Association. Supported by a team of renowned Editors, and fully Open Access, the journal encourages debate on controversial techniques, issues on health policy and social medicine.
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