Barras Christen D, Tress Brian M, Christensen Soren, MacGregor Lachlan, Collins Marnie, Desmond Patricia M, Skolnick Brett E, Mayer Stephan A, Broderick Joseph P, Diringer Michael N, Steiner Thorsten, Davis Stephen M
Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Stroke. 2009 Apr;40(4):1325-31. doi: 10.1161/STROKEAHA.108.536888. Epub 2009 Mar 12.
Intracerebral hemorrhage (ICH) growth predicts mortality and functional outcome. We hypothesized that irregular hematoma shape and density heterogeneity, reflecting active, multifocal bleeding or a variable bleeding time course, would predict ICH growth.
Three raters examined baseline sub-3-hour CT brain scans of 90 patients in the placebo arm of a Phase IIb trial of recombinant activated Factor VII in ICH. Each rater, blinded to growth data, independently applied novel 5-point categorical scales of density and shape to randomly presented baseline CT images of ICH. Density and shape were defined as either homogeneous/regular (Category 1 to 2) or heterogeneous/irregular (Category 3 to 5). Within- and between-rater reliability was determined for these scales. Growth was assessed as a continuous variable and using 3 binary definitions: (1) any ICH growth; (2) >or=33% or >or=12.5 mL ICH growth; and (3) radial growth >1 mm between baseline and 24-hour CT scan. Patients were divided into tertiles of baseline ICH volume: "small" (0 to 10 mL), "medium" (10 to 25 mL), and "large" (25 to 106 mL).
Inter- and intrarater agreements for the novel scales exceeded 85% (+/-1 category). Median growth was significantly higher in the large-volume group compared with the small group (P<0.001) and in heterogeneous compared with homogeneous ICH (P=0.008). Median growth trended higher in irregular ICHs compared with regular ICHs (P=0.084). Small ICHs were more regularly shaped (43%) than medium (17%) and large (3%) ICHs (P<0.001). Small ICHs were more homogeneous (73%) compared with medium (37%) and large (17%) ICHs (P<0.001). Adjusting for baseline ICH volume and time to scan, density heterogeneity, but not shape irregularity, independently predicted ICH growth (P=0.046) on a continuous growth scale.
Large ICHs were significantly more irregular in shape, heterogeneous in density, and had greater growth. Density heterogeneity independently predicted ICH growth using some definitions.
脑出血（ICH）的血肿扩大可预测死亡率和功能转归。我们推测，不规则的血肿形状和密度异质性反映了活动性、多灶性出血或不同的出血时间过程，可预测ICH的血肿扩大。
在一项重组活化凝血因子VII治疗ICH的IIb期试验的安慰剂组中，3名评估者对90例患者3小时内的脑部CT基线扫描进行了检查。每位评估者在不知道血肿扩大数据的情况下，将新的5分密度和形状分类量表独立应用于随机呈现的ICH基线CT图像。密度和形状被定义为均匀/规则（1至2类）或不均匀/不规则（3至5类）。确定了这些量表在评估者内部和评估者之间的可靠性。血肿扩大作为一个连续变量进行评估，并使用3种二元定义：（1）任何ICH血肿扩大；（2）ICH血肿扩大≥33%或≥12.5 mL；（3）基线CT扫描与24小时CT扫描之间的径向扩大>1 mm。患者根据ICH基线体积分为三分位数：“小”（0至10 mL）、“中”（10至25 mL）和“大”（25至106 mL）。
新量表在评估者之间和评估者内部的一致性超过85%（±1类）。与小体积组相比，大体积组的血肿扩大中位数显著更高（P<0.001），不均匀ICH比均匀ICH的血肿扩大中位数显著更高（P=0.008）。与规则ICH相比，不规则ICH的血肿扩大中位数有更高的趋势（P=0.084）。小ICH比中ICH（17%）和大ICH（3%）形状更规则（43%）（P<0.001）。与中ICH（37%）和大ICH（17%）相比，小ICH更均匀（73%）（P<0.001）。在校正ICH基线体积和扫描时间后，密度异质性而非形状不规则性在连续血肿扩大量表上独立预测ICH血肿扩大（P=0.046）。
大ICH在形状上明显更不规则，密度上更不均匀，且血肿扩大更大。使用某些定义时，密度异质性可独立预测ICH血肿扩大。
