Koo Hae-Won, Jo Kyung-Il, Yeon Je-Young, Kim Jong-Soo, Hong Seung-Chyul
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery, Hana General Hospital, Cheongju, Korea.
J Neurol Sci. 2016 Aug 15;367:89-94. doi: 10.1016/j.jns.2016.05.040. Epub 2016 May 20.
There is no doubt that cerebral amyloid angiopathy (CAA) is a key risk factor for recurrent lobar ICH, however, the exact mechanism and interaction with MRI markers of disease severity are less well known. Centrum semiovale-perivascular spaces (CSO-PVS) have been suggested as adjunctive diagnostic criteria in order to enhance diagnostic power. The purposes of this study were to investigate the prevalence of CSO-PVS and its association with other imaging signatures {lobar microbleeds (CMB), cortical superficial siderosis (CSS), white matter hyperintensity (WMH)} in lobar ICH patients as well as recurrent lobar ICH risk, especially in patients taking antithrombotic agents.
This retrospective study included 85 patients who visited our institute between 2005 and 2013 with lobar ICH on magnetic resonance imaging(MRI). CSO-PVS were rated on axial T2-weighted sequences using a validated 2-point visual rating scale (high degree >20, low degree ≤20). The CSS, CMB and WMH were also evaluated. The relationship between CSO-PVS, CSS, CMB, antithrombotic usage and recurrent bleeding were explored.
A high degree of CSO-PVS was present in 71.8% of patients. The prevalence of CSS and CMB was higher in patients with a high degree of CSO-PVS (CSS, 49.2% vs. 16.7%, P=0.006; CMB count, 7.3% vs. 2.1%, P=0.002). A high degree of CSO-PVS and antithrombotic usage following lobar ICH was not associated with recurrent hemorrhage. In multivariate logistic regression analysis of predictors of recurrent lobar ICH in lobar ICH patients, post-ICH antithrombotics use and disseminated CSS are independently associated with increased risk of recurrent lobar ICH.
High-degree CSO-PVS is highly prevalent in probable cerebral amyloid angiopathy and is related to CSS and CMB. Disseminated CSS was associated with recurrent ICH in CAA. Our study might help physicians decide whether or not to use antithrombotic agents in hemorrhagic stroke patients with a high risk of ischemic stroke. A large prospective study is warranted to validate these findings.
毫无疑问，脑淀粉样血管病（CAA）是复发性脑叶脑出血的关键危险因素，然而，其确切机制以及与疾病严重程度的MRI标志物之间的相互作用尚不太清楚。半卵圆中心周围血管间隙（CSO-PVS）已被建议作为辅助诊断标准，以提高诊断效能。本研究的目的是调查CSO-PVS在脑叶脑出血患者中的患病率及其与其他影像学特征{脑叶微出血（CMB）、皮质表面铁沉积（CSS）、白质高信号（WMH）}的关系，以及复发性脑叶脑出血的风险，尤其是在服用抗血栓药物的患者中。
这项回顾性研究纳入了2005年至2013年间因脑叶脑出血而行磁共振成像（MRI）检查并就诊于我院的85例患者。使用经过验证的2分视觉评分量表（高度>20，低度≤20）在轴位T2加权序列上对CSO-PVS进行评分。同时对CSS、CMB和WMH进行评估。探讨CSO-PVS、CSS、CMB、抗血栓药物使用与复发性出血之间的关系。
71.8%的患者存在高度CSO-PVS。高度CSO-PVS患者的CSS和CMB患病率更高（CSS，49.2%对16.7%，P=0.006；CMB计数，7.3%对2.1%，P=0.002）。脑叶脑出血后高度CSO-PVS和抗血栓药物的使用与复发性出血无关。在脑叶脑出血患者复发性脑叶脑出血预测因素的多因素逻辑回归分析中，脑出血后使用抗血栓药物和弥漫性CSS与复发性脑叶脑出血风险增加独立相关。
高度CSO-PVS在可能的脑淀粉样血管病中高度普遍，且与CSS和CMB相关。弥漫性CSS与CAA中的复发性脑出血相关。我们的研究可能有助于医生决定是否对有缺血性中风高风险的出血性中风患者使用抗血栓药物。需要进行大规模前瞻性研究来验证这些发现。
