Department of Radiology, The First Hospital of Jilin University, Changchun, China.
Cancer Center, The First Hospital of Jilin University, Changchun, China.
Sci Prog. 2020 Apr-Jun;103(2):36850420924153. doi: 10.1177/0036850420924153.
Symptomatic intracerebral hemorrhage is a serious potential complication of recombinant tissue-type plasminogen activator thrombolysis in acute ischemic stroke. We investigated the optimal imaging and clinical parameters to predict symptomatic intracerebral hemorrhage in acute ischemic stroke patients after recombinant tissue-type plasminogen activator therapy. We retrospectively reviewed 151 acute ischemic stroke patients with thrombolytic therapy, who were dichotomized into symptomatic intracerebral hemorrhage group and non-symptomatic intracerebral hemorrhage group. They underwent multimodal computed tomography, including the measurement of permeability surface. We compared the clinical and radiological characteristics between symptomatic intracerebral hemorrhage group and non-symptomatic intracerebral hemorrhage group, using univariate analysis. Receiver operating characteristic analysis and multivariate logistic regression analyses were then used to determine symptomatic intracerebral hemorrhage predictors. Of 151 patients, 14 patients (9.27%) developed symptomatic intracerebral hemorrhage on follow-up imaging. Relative permeability surface (infarct permeability surface/contralateral normal permeability surface) ( < 0.05) and baseline low-density lipoprotein cholesterol level ( < 0.05) were both predictors of symptomatic intracerebral hemorrhage. Receiver operating characteristic analysis of relative permeability surface revealed an optimal relative permeability surface threshold of 2.239, with an area under the curve of 0.87 (95% confidence interval, 0.732-1.0). The relative permeability surface was 2.239, the sensitivity for symptomatic intracerebral hemorrhage was 85.7%, the specificity was 94.9%, the positive predictive value was 70.6%, and the negative predictive value was 95.5%. For low-density lipoprotein cholesterol, the optimal threshold was 2.45, with an area under the curve of 0.726 (95% confidence interval, 0.586-0.867), the sensitivity for symptomatic intracerebral hemorrhage was 73.0%, the specificity was 64.3%, the positive predictive value was 67.16%, and the negative predictive value was 79.09%. Our study demonstrated that increased infarct permeability surface and low level of low-density lipoprotein cholesterol can be two predictors of symptomatic intracerebral hemorrhage. Detection of relative permeability surface and low-density lipoprotein cholesterol may help clinicians to identify acute ischemic stroke patients with the higher risk of symptomatic intracerebral hemorrhage; intravenous thrombolytic therapy should be carefully performed for patients with high relative permeability surface and low low-density lipoprotein cholesterol. We may take relative permeability surface and low-density lipoprotein cholesterol into account to refine therapeutic decision-making in acute ischemic stroke.
症状性颅内出血是急性缺血性卒中重组组织型纤溶酶原激活物溶栓治疗的严重潜在并发症。我们研究了最佳的影像学和临床参数，以预测急性缺血性卒中患者接受重组组织型纤溶酶原激活物治疗后的症状性颅内出血。我们回顾性分析了 151 例接受溶栓治疗的急性缺血性卒中患者，将其分为症状性颅内出血组和非症状性颅内出血组。他们接受了多模态计算机断层扫描，包括通透性表面的测量。我们使用单因素分析比较了症状性颅内出血组和非症状性颅内出血组之间的临床和影像学特征。然后，我们使用受试者工作特征分析和多变量逻辑回归分析来确定症状性颅内出血的预测因子。在 151 例患者中，14 例（9.27%）在随访影像学检查中出现症状性颅内出血。相对通透性表面（梗死通透性表面/对侧正常通透性表面）（ < 0.05）和基线低密度脂蛋白胆固醇水平（ < 0.05）均为症状性颅内出血的预测因子。相对通透性表面的受试者工作特征分析显示，相对通透性表面的最佳阈值为 2.239，曲线下面积为 0.87（95%置信区间，0.732-1.0）。相对通透性表面为 2.239，症状性颅内出血的敏感性为 85.7%，特异性为 94.9%，阳性预测值为 70.6%，阴性预测值为 95.5%。对于低密度脂蛋白胆固醇，最佳阈值为 2.45，曲线下面积为 0.726（95%置信区间，0.586-0.867），症状性颅内出血的敏感性为 73.0%，特异性为 64.3%，阳性预测值为 67.16%，阴性预测值为 79.09%。我们的研究表明，增加的梗死通透性表面和低水平的低密度脂蛋白胆固醇可以成为症状性颅内出血的两个预测因子。检测相对通透性表面和低密度脂蛋白胆固醇可能有助于临床医生识别具有较高症状性颅内出血风险的急性缺血性卒中患者；对于相对通透性表面和低密度脂蛋白胆固醇较高的患者，应谨慎进行静脉溶栓治疗。我们可以考虑相对通透性表面和低密度脂蛋白胆固醇来完善急性缺血性卒中的治疗决策。
