Wilson Duncan, Ogungbemi Ayokunle, Ambler Gareth, Jones Ifan, Werring David J, Jäger Hans R
1Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
2Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Eur Stroke J. 2017 Dec;2(4):369-376. doi: 10.1177/2396987317732874. Epub 2017 Sep 19.
Determining the cause of spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is critical to guide treatment and prognosis. We investigated whether small vessel disease (SVD) in addition to clinical and other radiological findings on acute neuroimaging predicts a low risk of a macrovascular cause (e.g. an arterio-venous malformation, aneurysm or dural arteriovenous fistula).
We identified patients with acute spontaneous ICH who underwent acute non-contrast CT, CT angiography (CTA) and intra-arterial digital subtraction angiography (IADSA) at our institution from January 2010 to April 2014. Logistic regression including CTA result, SVD, age, pre-ICH hypertension and ICH location was used to derive a prediction model, validated using bootstrapping.
173 patients (46% female, median age 49) of whom 78 had a macrovascular cause on IADSA were included. Predictors of a macrovascular cause were: abnormal CTA (OR 67.4; < 0.001); absence of SVD (OR 5.0; = 0.019); and absence of pre-ICH hypertension (OR 3.4; = 0.05). In our internally derived prediction model, the combination of CTA, SVD and pre-ICH hypertension predicted the likelihood of an underlying macrovascular cause (optimism-adjusted ROC area 0.919). Patients with negative CTA, SVD and pre-ICH hypertension have a low likelihood of an underlying macrovascular cause (1.8%).
A combination of CTA, SVD and pre-ICH hypertension predict the likelihood of finding a macrovascular cause in patients with acute spontaneous ICH, allowing informed decisions regarding the likely benefit and risk of IADSA.
确定自发性（非创伤性）脑出血（ICH）的病因对于指导治疗和判断预后至关重要。我们研究了除急性神经影像学检查的临床及其他影像学表现外，小血管疾病（SVD）是否预示大血管病因（如动静脉畸形、动脉瘤或硬脑膜动静脉瘘）的风险较低。
我们纳入了2010年1月至2014年4月期间在我院接受急性非增强CT、CT血管造影（CTA）和动脉内数字减影血管造影（IADSA）的急性自发性ICH患者。采用逻辑回归分析，纳入CTA结果、SVD、年龄、ICH前高血压及ICH部位等因素建立预测模型，并通过自抽样法进行验证。
共纳入173例患者（46%为女性，中位年龄49岁），其中78例经IADSA检查发现存在大血管病因。大血管病因的预测因素包括：CTA异常（比值比[OR]67.4；P<0.001）；无SVD（OR 5.0；P = 0.019）；无ICH前高血压（OR 3.4；P = 0.05）。在我们内部建立的预测模型中，CTA、SVD和ICH前高血压的联合可预测潜在大血管病因的可能性（乐观校正的受试者工作特征曲线下面积为0.919）。CTA、SVD及ICH前高血压均为阴性的患者，潜在大血管病因的可能性较低（1.8%）。
CTA、SVD和ICH前高血压的联合可预测急性自发性ICH患者存在大血管病因的可能性，有助于就IADSA可能的获益和风险做出明智决策。
