Schneider Tanja, Frieling David, Schroeder Julian, Regelsberger Jan, Schoen Gerhard, Fiehler Jens, Gellißen Susanne
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology, Schön Klinik Hamburg Eilbek, Hamburg, Germany.
PLoS One. 2017 Sep 18;12(9):e0184518. doi: 10.1371/journal.pone.0184518. eCollection 2017.
There is growing evidence that a perihematomal area of restricted diffusion (PDR) exists in intraparenchymal hemorrhages (IPH) within 1 week of symptom onset (SO). Here, we study characteristics and the clinical impact of the PDR in patients with hyperacute (≤ 6 hours from SO) IPH by means of apparent diffusion coefficient (ADC).
This monocentric, retrospective study includes 83 patients with first-ever primary IPH from 09/2002-10/2015. 3D volumetric segmentation was performed for the IPH, PDR, and perihematomal edema (PHE) on fluid-attenuated inversion recovery, T2*/susceptibility weighted images, and ADC images.
A PDR was seen in 56/83 patients (67.5%) presenting with hyperacute IPH. Multivariate logistic regression analysis revealed every 10-year increase of age (HR 1.929, 95% CI 1.047-3.552, P = .035) and male gender (HR 5.672, 95% CI 1.038-30.992, P = .045) as significant predictors of the presence of a PDR, but not IPH size, IPH location, nor National Institutes of Health Stroke Scale Score (NIHSS) at admission. We found no difference in NIHSS at discharge, hematoma removal, or mortality rate in PDR-positive patients. ADC values of the PDR show a step-wise normalization with increasing time from SO.
Occurrence of a PDR is a common finding in supratentorial hyperacute IPH, but shows no adverse short-term clinical impact. It may represent transient oligemic and metabolic changes.
越来越多的证据表明，在症状发作（SO）1周内的脑实质内出血（IPH）中存在血肿周围扩散受限区域（PDR）。在此，我们通过表观扩散系数（ADC）研究超急性（距SO≤6小时）IPH患者中PDR的特征及其临床影响。
这项单中心回顾性研究纳入了2002年9月至2015年10月期间首次发生原发性IPH的83例患者。在液体衰减反转恢复序列、T2* / susceptibility加权图像和ADC图像上对IPH、PDR和血肿周围水肿（PHE）进行三维体积分割。
83例超急性IPH患者中有56例（67.5%）出现PDR。多因素逻辑回归分析显示，年龄每增加10岁（HR 1.929，95%CI 1.047 - 3.552，P = 0.035）和男性（HR 5.672，95%CI 1.038 - 30.992，P = 0.045）是PDR存在的显著预测因素，但不是IPH大小、IPH位置或入院时的美国国立卫生研究院卒中量表评分（NIHSS）。我们发现PDR阳性患者出院时的NIHSS、血肿清除情况或死亡率没有差异。PDR的ADC值随距SO时间增加呈逐步正常化。
PDR的出现是幕上超急性IPH中的常见表现，但在短期临床中没有不良影响。它可能代表短暂的低灌注和代谢变化。
