Garg Rajeev K, Khan Jawad, Dawe Robert J, Conners James, John Sayona, Prabhakaran Shyam, Kocak Mehmet, Bhabad Sudeep, Simpson Sean L, Ouyang Bichun, Jhaveri Miral, Bleck Thomas P
Rush University Medical Center, 1725 West Harrison Street, Suite 1106, Chicago, IL, 60612, USA.
University of Chicago, Chicago, IL, USA.
Neurocrit Care. 2020 Oct;33(2):552-564. doi: 10.1007/s12028-020-00933-3.
BACKGROUND/OBJECTIVE: Diffusion weighted imaging (DWI) lesions have been well described in patients with acute spontaneous intracerebral hemorrhage (sICH). However, there are limited data on the influence of these lesions on sICH functional outcomes. We conducted a prospective observational cohort study with blinded imaging and outcomes assessment to determine the influence of DWI lesions on long-term outcomes in patients with acute sICH. We hypothesized that DWI lesions are associated with worse modified Rankin Scale (mRS) at 3 months after hospital discharge.
Consecutive sICH patients meeting study criteria were consented for an magnetic resonance imaging (MRI) scan of the brain and evaluated for remote DWI lesions by neuroradiologists blinded to the patients' hospital course. Blinded mRS outcomes were obtained at 3 months. Logistic regression was used to determine significant factors (p < 0.05) associated with worse functional outcomes defined as an mRS of 4-6. The generalized estimating equation (GEE) approach was used to investigate the effect of DWI lesions on dichotomized mRS (0-3 vs 4-6) longitudinally.
DWI lesions were found in 60 of 121 patients (49.6%). The presence of a DWI lesion was associated with increased odds for an mRS of 4-6 at 3 months (OR 5.987, 95% CI 1.409-25.435, p = 0.015) in logistic regression. Using the GEE model, patients with a DWI lesion were less likely to recover over time between 14 days/discharge and 3 months (p = 0.005).
DWI lesions are common in primary sICH, occurring in almost half of our cohort. Our data suggest that DWI lesions are associated with worse mRS at 3 months in good grade sICH and are predictive of impaired recovery after hospital discharge. Further research into the pathophysiologic mechanisms underlying DWI lesions may lead to novel treatment options that may improve outcomes associated with this devastating disease.
背景/目的：急性自发性脑出血（sICH）患者的扩散加权成像（DWI）病变已有充分描述。然而，关于这些病变对sICH功能结局影响的数据有限。我们进行了一项前瞻性观察队列研究，采用盲法影像和结局评估，以确定DWI病变对急性sICH患者长期结局的影响。我们假设DWI病变与出院后3个月时改良Rankin量表（mRS）评分较差有关。
符合研究标准的连续sICH患者同意接受脑部磁共振成像（MRI）扫描，并由对患者住院过程不知情的神经放射科医生评估是否存在远处DWI病变。在3个月时获得盲法mRS结局。采用逻辑回归确定与功能结局较差（定义为mRS为4 - 6）相关的显著因素（p < 0.05）。采用广义估计方程（GEE）方法纵向研究DWI病变对二分法mRS（0 - 3 vs 4 - 6）的影响。
121例患者中有60例（49.6%）发现DWI病变。在逻辑回归中，DWI病变的存在与3个月时mRS为4 - 6的几率增加相关（OR 5.987，95% CI 1.409 - 25.435，p = 0.015）。使用GEE模型，有DWI病变的患者在14天/出院至3个月期间随时间恢复的可能性较小（p = 0.005）。
DWI病变在原发性sICH中很常见，在我们的队列中几乎占一半。我们的数据表明，在病情较轻的sICH患者中，DWI病变与3个月时较差的mRS相关，并且可预测出院后恢复受损。对DWI病变潜在病理生理机制的进一步研究可能会带来新的治疗选择，从而改善与这种毁灭性疾病相关的结局。
