Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Neurointerv Surg. 2012 Jul;4(4):256-60. doi: 10.1136/neurintsurg-2011-010062. Epub 2011 Aug 10.
A positive correlation between large parenchymal hematoma (PH) volume and large CT lesion volume in subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) as well as placebo controls was identified in the European Cooperative Acute Stroke Study II (ECASS II). A study was undertaken to examine the relationship between PH volume and total lesion volume (including both cerebral infarction and hemorrhage) in subjects with symptomatic parenchymal hematoma (sPH) treated with combined IV and intra-arterial (IA) rtPA in the Interventional Management of Stroke (IMS) studies.
Hematoma and lesion volumes were measured planimetrically and by the ABC/2 method in 105 subjects from IMS studies I and II following combined IV and IA rtPA treatment. PH type 1 or 2 was determined by dichotomizing at >30% of lesion volume. Hematoma and lesion volumes for both symptomatic PH1 (sPH1) and PH2 (sPH2) types were compared using both measurement methods. Both sPH types were compared for baseline NIH Stroke Score, baseline Alberta Stroke Program Early CT score and treatment revascularization score based on the planimetric volume method.
The volume of sPH1 and sPH2 did not differ by either method of measurement. Subjects with sPH2 had a lower lesion volume compared with all PH1 (p=0.004) and sPH1 (p=0.02) by both methods. The ABC/2 method overestimated PH volume by 55±33% and lesion volume by 34±22% for sPH compared with the planimetric method.
In IMS I and II, hemorrhages in subjects with sPH2 were similar in volume to those in subjects with sPH1 and were associated with a smaller rather than a larger total lesion volume compared with other PH in the setting of combined IV/IA therapy. The use of PH2 as a sole surrogate for sPH in studies of stroke treatment may underestimate the incidence of clinically significant hemorrhage.
在接受静脉（IV）重组组织型纤溶酶原激活剂（rtPA）和安慰剂对照治疗的患者中，欧洲合作急性卒中研究 II（ECASS II）发现大实质血肿（PH）体积与 CT 病变体积之间存在正相关。进行了一项研究，以检查在接受联合 IV 和动脉内（IA）rtPA 治疗的有症状实质血肿（sPH）患者中，PH 体积与总病变体积（包括脑梗死和出血）之间的关系，该研究来自于干预性卒中管理（IMS）研究。
在 IMS 研究 I 和 II 中，105 例接受联合 IV 和 IA rtPA 治疗的患者，通过平面测量法和 ABC/2 法测量血肿和病变体积。通过将血肿体积大于 30%的病变体积分为 PH 1 型或 2 型来确定 PH 类型 1 或 2。使用两种测量方法比较两种症状性 PH1（sPH1）和 PH2（sPH2）类型的血肿和病变体积。基于平面测量法的体积，使用 NIH 卒中量表、阿尔伯塔卒中项目早期 CT 评分和治疗再通评分对两种 sPH 类型进行比较。
两种测量方法均显示 sPH1 和 sPH2 的体积无差异。与所有 PH1（p=0.004）和 sPH1（p=0.02）相比，sPH2 患者的病变体积较小。与平面测量法相比，ABC/2 法高估了 sPH 的血肿体积 55±33%，病变体积 34±22%。
在 IMS I 和 II 中，与 sPH1 相比，sPH2 患者的血肿体积相似，与联合 IV/IA 治疗中其他 PH 相比，sPH2 患者的总病变体积较小，而不是较大。在卒中治疗研究中，仅将 PH2 作为 sPH 的替代指标可能会低估临床显著出血的发生率。
