Université de Lyon, Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France.
Stroke. 2013 Aug;44(8):2318-20. doi: 10.1161/STROKEAHA.113.001751. Epub 2013 May 30.
Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization.
The volume of cerebral tissue with CBV≤2.5th percentile of the normal hemisphere was calculated within the acute diffusion-weighted imaging lesion. Hemorrhagic transformation was assessed on day 2 MRI according to the European Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI.
Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score (P=0.002), acute diffusion-weighted imaging lesion volume (P=0.02), and thrombolysis (P=0.03), but not very low CBV (P=0.52), were associated with hemorrhagic transformation. The volume of very low CBV was the only predictor of PH (P=0.007). Early reperfusion and recanalization had no influence on either hemorrhagic transformation or PH.
Very low CBV was the only independent predictor of PH in patients with acute stroke.
脑实质血肿（PH）可能使脑卒中患者的预后恶化。本研究旨在通过欧洲多中心数据库（I-KNOW）证实脑血容量（CBV）极低与 PH 之间的关系。次要目的是探讨早期再灌注和再通的影响。
在急性弥散加权成像病变内计算 CBV≤正常半球第 2.5 百分位数的脑组织体积。根据欧洲合作急性脑卒中研究 II 标准，在第 2 天 MRI 上评估出血性转化。在 3 小时的随访 MRI 上评估再通和再灌注情况。
在 110 例患者中，59 例发生出血性转化，包括 7 例 PH。在单变量分析中，急性国立卫生研究院脑卒中量表评分（P=0.002）、急性弥散加权成像病变体积（P=0.02）和溶栓治疗（P=0.03）与出血性转化相关，而 CBV 极低（P=0.52）与出血性转化无关。极低 CBV 体积是 PH 的唯一预测因子（P=0.007）。早期再灌注和再通对出血性转化或 PH 均无影响。
在急性脑卒中患者中，极低 CBV 是 PH 的唯一独立预测因子。
