Zimmer Sebastian, Meier Jörn, Minnerup Jens, Wildgruber Moritz, Broocks Gabriel, Nawabi Jawed, Morotti Andrea, Kemmling Andre, Psychogios Marios, Hanning Uta, Sporns Peter B
Institute of Clinical Radiology, Westfaelische Wilhelms-University of Münster and University Hospital of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany.
Department of Medicine B, University Hospital Münster, 48149 Münster, Germany.
J Clin Med. 2020 Apr 10;9(4):1077. doi: 10.3390/jcm9041077.
In patients with spontaneous intracerebral hemorrhage (ICH), several non-contrast computed tomography (NCCT) markers and the spot sign (SS) in computed tomography (CT) angiography (CTA) have been established for the prediction of hematoma growth and neurological outcome. However, the prognostic value of these markers in patients under oral anticoagulation (ORAC) is unclear. We hypothesized that outcome prediction by these imaging markers may be significantly different between patients with and without ORAC. Therefore, we aimed to investigate the predictive value of NCCT markers and SS in patients with ICH under ORAC.
This is a retrospective study of the database for patients with ICH at a German tertiary stroke center. Inclusion criteria were (1) patients with ICH, (2) oral anticoagulation within the therapeutic range, and (3) NCCT and CTA performed on admission within 6 h after onset of symptoms. We defined a binary outcome: modified Rankin Scale (mRS) ≤ 3 = good outcome versus mRS > 3 = poor outcome at discharge. The predictive value of each sign was assessed in uni- and multivariable logistic regression models.
Of 129 patients with ICH under ORAC, 76 (58.9%) presented with hypodensities within the hematoma in admission NCCT, 64 (52.7%) presented with an irregular shape of the hematoma, 60 (46.5%) presented with a swirl sign, 49 (38.0%) presented with a black hole sign, and 46 (35.7%) presented with a heterogeneous density of the hematoma. Moreover, 44 (34.1%) patients had a satellite sign, in 20 (15.5%) patients, an island sign was detected, 18 (14.0%) patients were blend-sign positive, and 14 (10.9%) patients presented with a CTA spot sign. Inter-rater agreement was very high for all included characteristics between the two readers. Multivariable logistic regression analysis identified the presence of black hole sign (odds ratio 10.59; < 0.001), swirl sign (odds ratio 14.06; < 0.001), and satellite sign (odds ratio 6.38; = 0.011) as independent predictors of poor outcome.
The distribution and prognostic value of several NCCT markers and CTA spot sign in ICH patients under ORAC is comparable to those with spontaneous ICH, even though these parameters are partly based on coagulant status. These findings suggest that a similar approach can be used for further research regarding outcome prediction in ICH patients under ORAC and those with spontaneous ICH.
在自发性脑出血（ICH）患者中，已确定了几种非增强计算机断层扫描（NCCT）标志物以及计算机断层扫描（CT）血管造影（CTA）中的斑点征（SS），用于预测血肿扩大和神经功能结局。然而，这些标志物在口服抗凝剂（ORAC）治疗的患者中的预后价值尚不清楚。我们推测，这些影像学标志物对预后的预测在有和没有ORAC治疗的患者中可能存在显著差异。因此，我们旨在研究NCCT标志物和SS在接受ORAC治疗的ICH患者中的预测价值。
这是一项对德国一家三级卒中中心的ICH患者数据库进行的回顾性研究。纳入标准为：（1）ICH患者；（2）处于治疗范围内的口服抗凝治疗；（3）症状发作后6小时内入院时进行NCCT和CTA检查。我们定义了一个二元结局：改良Rankin量表（mRS）≤3=出院时预后良好，mRS>3=出院时预后不良。在单变量和多变量逻辑回归模型中评估每个征象的预测价值。
在129例接受ORAC治疗的ICH患者中，76例（58.9%）在入院NCCT中血肿内出现低密度影，64例（52.7%）血肿形状不规则，60例（46.5%）出现漩涡征，49例（38.0%）出现黑洞征，46例（35.7%）血肿密度不均匀。此外，44例（34.1%）患者有卫星征，20例（15.5%）患者检测到岛征，18例（14.0%）患者混合征阳性，14例（10.9%）患者出现CTA斑点征。两位阅片者对所有纳入特征的评分者间一致性非常高。多变量逻辑回归分析确定黑洞征（比值比10.59；<0.001）、漩涡征（比值比14.06；<0.001）和卫星征（比值比6.38；=0.011）是预后不良的独立预测因素。
尽管这些参数部分基于凝血状态，但在接受ORAC治疗的ICH患者中，几种NCCT标志物和CTA斑点征的分布及预后价值与自发性ICH患者相当。这些发现表明，对于接受ORAC治疗的ICH患者和自发性ICH患者的预后预测，可采用类似方法进行进一步研究。
