Wallace Adam N, Vyhmeister Ross, Dines Jeffrey N, Chatterjee Arindam R, Kansagra Akash P, Viets Ryan, Whisenant Justin T, Moran Christopher J, Cross DeWitte T, Derdeyn Colin P
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA.
Washington University School of Medicine, St Louis, Missouri, USA.
J Neurointerv Surg. 2016 Apr;8(4):378-85. doi: 10.1136/neurintsurg-2015-011680. Epub 2015 Mar 23.
Perimesencephalic subarachnoid hemorrhage (PSAH) is not consistently defined in the existing literature. The purpose of this study was to test the inter-observer variability and specificity for non-aneurysmal subarachnoid hemorrhage (SAH) of an anatomic definition of PSAH.
Medical records of all patients who underwent catheter angiography for evaluation of non-traumatic SAH between July 2002 and April 2012 were reviewed. Patients with anterior circulation aneurysms were excluded. Three blinded reviewers assessed whether each admission CT scan met the following anatomic criteria for PSAH: (1) center of bleeding located immediately anterior and in contact with the brainstem in the prepontine, interpeduncular, or posterior suprasellar cistern; (2) blood limited to the prepontine, interpeduncular, suprasellar, crural, ambient, and/or quadrigeminal cisterns and/or cisterna magna; (3) no extension of blood into the Sylvian or interhemispheric fissures; (4) intraventricular blood limited to incomplete filling of the fourth ventricle and occipital horns of the lateral ventricles (ie, consistent with reflux); (5) no intraparenchymal blood.
56 patients with non-aneurysmal SAH and 50 patients with posterior circulation or posterior communicating artery aneurysms were identified. Seventeen (16%) of the 106 admission CT scans met the anatomic criteria for PSAH. No aneurysm was identified in this subgroup. Inter-observer agreement was excellent with κ scores of 0.89-0.96 and disagreement in 2.8% (3/106) of cases.
Our anatomic definition of PSAH correlated with a low risk of brain aneurysm and was applied with excellent inter-observer agreement.
中脑周围蛛网膜下腔出血（PSAH）在现有文献中尚无统一的定义。本研究旨在检验PSAH解剖学定义对非动脉瘤性蛛网膜下腔出血（SAH）的观察者间变异性及特异性。
回顾性分析2002年7月至2012年4月间所有因非创伤性SAH接受导管血管造影评估的患者的病历。排除前循环动脉瘤患者。三名盲法观察者评估每次入院时的CT扫描是否符合PSAH的以下解剖学标准：（1）出血中心位于脑桥前、脚间或鞍上池后方，紧邻脑干且与之接触；（2）血液局限于脑桥前、脚间、鞍上、大脑脚、环池和/或四叠体池及/或枕大池；（3）血液未延伸至外侧裂或大脑纵裂；（4）脑室内血液仅限于第四脑室及侧脑室枕角不完全充盈（即符合反流）；（5）无脑实质内出血。
共纳入56例非动脉瘤性SAH患者及50例后循环或后交通动脉瘤患者。106次入院CT扫描中有17次（16%）符合PSAH的解剖学标准。该亚组未发现动脉瘤。观察者间一致性良好，κ值为0.89 - 0.96，2.8%（3/106）的病例存在分歧。
我们对PSAH的解剖学定义与脑动脉瘤低风险相关，且观察者间一致性良好。
