1 Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
2 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Int J Stroke. 2018 Jan;13(1):24-34. doi: 10.1177/1747493017730781. Epub 2017 Sep 18.
Background Case-fatality rates after aneurysmal subarachnoid hemorrhage have decreased over the past decades. However, many patients who survive an aneurysmal subarachnoid hemorrhage have long-term functional and cognitive impairments. Aims We sought to review all data on conventional brain MRI obtained in the chronic phase after aneurysmal subarachnoid hemorrhage to (1) analyze the proportion of patients with cerebral infarction or brain volume changes; (2) investigate baseline determinants predictive of MRI-detected damage; and (3) assess if brain damage is predictive of patient outcome. Summary of review All original data published between 1 January 2000 and 4 October 2017 was searched using the PUBMED, EMBASE, and Web of Science databases. Based on preset inclusion criteria, 15 from 5200 articles were included with a total of 996 aneurysmal subarachnoid hemorrhage patients. Quality assessment, risk of bias assessment, and level of evidence assessment were performed. The results according to aim, with levels of evidence, were: (1) 25 to 81% of aneurysmal subarachnoid hemorrhage patients show infarcts (strong); there is a higher ratio of cerebrospinal fluid-to-intracranial volume in patients compared to controls (strong); (2) there is a negative relation between age (moderate), DCI (low) and brain volume measurement outcomes; (3) lower brain parenchymal volume (strong) and the presence of infarcts or infarct volumes (moderate) are associated with a worse outcome. Conclusion Patients after aneurysmal subarachnoid hemorrhage may demonstrate brain infarcts and decreased brain parenchyma, which is related to worse outcome. Thereby, both brain infarcts and brain volume measurements could be used as outcome markers in pharmaceutical trials. Systematic Review Registration PROSPERO CRD42016040095.
在过去几十年中，蛛网膜下腔出血后患者的病死率已降低。然而，许多幸存的蛛网膜下腔出血患者存在长期的功能和认知障碍。
我们旨在回顾所有关于蛛网膜下腔出血后慢性期常规脑 MRI 的数据，以（1）分析脑梗死或脑容量变化患者的比例；（2）研究基线预测 MRI 检测到的损伤的决定因素；（3）评估脑损伤是否对患者预后有预测作用。
从 2000 年 1 月 1 日至 2017 年 10 月 4 日，使用 PUBMED、EMBASE 和 Web of Science 数据库搜索了所有已发表的原始数据。根据预设的纳入标准，从 5200 篇文章中筛选出 15 篇，共纳入 996 例蛛网膜下腔出血患者。进行了质量评估、偏倚风险评估和证据水平评估。根据目的、证据水平的结果如下：（1）25%至 81%的蛛网膜下腔出血患者出现梗死（强）；与对照组相比，患者的脑脊液与颅内容积比更高（强）；（2）年龄（中度）、DCI（低）和脑容量测量结果之间存在负相关；（3）脑实质体积较低（强）和存在梗死或梗死体积（中度）与预后不良相关。
蛛网膜下腔出血后患者可能表现出脑梗死和脑实质减少，这与预后不良有关。因此，脑梗死和脑容量测量都可以作为药物试验的预后标志物。
PROSPERO CRD42016040095。
