Haider Stefan P, Qureshi Adnan I, Jain Abhi, Tharmaseelan Hishan, Berson Elisa R, Majidi Shahram, Filippi Christopher G, Mak Adrian, Werring David J, Acosta Julian N, Malhotra Ajay, Kim Jennifer A, Sansing Lauren H, Falcone Guido J, Sheth Kevin N, Payabvash Seyedmehdi
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany.
Int J Stroke. 2022 Aug;17(7):777-784. doi: 10.1177/17474930211050749. Epub 2021 Oct 13.
Among prognostic imaging variables, the hematoma volume on admission computed tomography (CT) has long been considered the strongest predictor of outcome and mortality in intracerebral hemorrhage.
To examine whether different features of hematoma shape are associated with functional outcome in deep intracerebral hemorrhage.
We analyzed 790 patients from the ATACH-2 trial, and 14 shape features were quantified. We calculated Spearman's Rho to assess the correlation between shape features and three-month modified Rankin scale (mRS) score, and the area under the receiver operating characteristic curve (AUC) to quantify the association between shape features and poor outcome defined as mRS>2 as well as mRS > 3.
Among 14 shape features, the maximum intracerebral hemorrhage diameter in the coronal plane was the strongest predictor of functional outcome, with a maximum coronal diameter >∼3.5 cm indicating higher three-month mRS scores. The maximum coronal diameter versus hematoma volume yielded a Rho of 0.40 versus 0.35 ( = 0.006), an AUC of 0.71 versus 0.68 ( = 0.004), and an AUC of 0.71 versus 0.69 ( = 0.029). In multiple regression analysis adjusted for known outcome predictors, the maximum coronal diameter was independently associated with three-month mRS (p < 0.001).
A coronal-plane maximum diameter measurement offers greater prognostic value in deep intracerebral hemorrhage than hematoma volume. This simple shape metric may expedite assessment of admission head CTs, offer a potential biomarker for hematoma size eligibility criteria in clinical trials, and may substitute volume in prognostic intracerebral hemorrhage scoring systems.
在预后影像变量中，入院时计算机断层扫描（CT）上的血肿体积长期以来一直被认为是脑出血预后和死亡率的最强预测指标。
研究深部脑出血中血肿形状的不同特征是否与功能预后相关。
我们分析了ATACH-2试验中的790例患者，并对14种形状特征进行了量化。我们计算了Spearman等级相关系数以评估形状特征与三个月改良Rankin量表（mRS）评分之间的相关性，并计算了受试者操作特征曲线下面积（AUC）以量化形状特征与定义为mRS>2以及mRS>3的不良预后之间的关联。
在14种形状特征中，冠状面内脑出血的最大直径是功能预后的最强预测指标，冠状面最大直径>∼3.5 cm表明三个月mRS评分较高。冠状面最大直径与血肿体积相比，Spearman等级相关系数为0.40对0.35（P=0.006），AUC为0.71对0.68（P=0.004），以及AUC为0.71对0.69（P=0.029）。在针对已知预后预测因素进行调整的多元回归分析中，冠状面最大直径与三个月mRS独立相关（P<0.001）。
在深部脑出血中，冠状面最大直径测量比血肿体积具有更大的预后价值。这种简单的形状指标可能会加快对入院头部CT的评估，为临床试验中的血肿大小合格标准提供潜在的生物标志物，并且可能在脑出血预后评分系统中替代体积指标。
