Qin Bin, Xiang Yi, Zheng Jianfeng, Xu Rui, Guo Zongduo, Cheng Chongjie, Jiang Li, Wu Yue, Sun Xiaochuan, Huang Zhijian
Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurosurgery, The Second People's Hospital of Jiulongpo District, Chongqing, China.
Front Neurol. 2021 Oct 8;12:654419. doi: 10.3389/fneur.2021.654419. eCollection 2021.
Primary brain swelling occurs in aneurysmal subarachnoid hemorrhage (aSAH) patients. The absence of a dynamic quantitative method restricts further study of primary brain swelling. This study compared differences in the change rate of brain volume (CRBV) between patients with and without primary brain swelling in the early stage of aSAH. Moreover, the relationship between CRBV and clinical outcomes was evaluated. Patients hospitalized within 24 h after aSAH were included in this retrospective study. Utilizing a qualitative standard established before the study to recognize primary brain swelling through brain CT after aSAH, clinical outcomes after 3 months of SAH were evaluated with a modified Rankin scale (mRS). The brain volume (BV) of each patient was calculated with a semiautomatic threshold algorithm of 3D-slicer, and the change in brain volume (CIBV) was obtained by subtracting the two extreme values (CIBV = BV - BV). The CRBV was obtained by CIBV/BV × 100%. The CRBV values that predicted unfavorable prognoses were estimated. In total, 130 subjects were enrolled in the study. The mean CRBV in the non-swelling group and swelling group were 4.37% (±4.77) and 11.87% (±6.84), respectively ( < 0.05). CRBV was positively correlated with the length of hospital stay, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume (Spearman ρ = 0.334; < 0.001; Pearson ρ = 0.269, = 0.002; Pearson ρ = 0.278, = 0.001; Pearson ρ = 0.233, = 0.008, respectively). Analysis of variance showed significant differences in CIBV, CRBV, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume among varying modified Fisher scale (mFisher), with higher admission mFisher scale, indicating larger values of these variables. After adjusting for risk factors, the model showed that for every 1% increase in the CRBV, the probability of poor clinical prognosis increased by a factor of 1.236 (95% CI = 1.056-1.446). In the stratified analysis, the odds of worse clinical outcomes increased with increases in the CRBV. Receiver operating characteristic curve analysis showed that HH grade, mFisher scale, and score of CRBV (SCRBV) had diagnostic performance for predicting unfavorable clinical outcomes. Primary brain swelling increases brain volume after aSAH. The CRBV quantified by 3D-Slicer can be used as a volumetric representation of the degree of brain swelling. A larger CRBV in the early stage of aSAH is associated with poor prognosis. The CRBV can be used as a neuroimaging biomarker of early brain injury after bleeding and may be an effective predictor of patients' clinical prognoses.
原发性脑肿胀发生在动脉瘤性蛛网膜下腔出血（aSAH）患者中。缺乏动态定量方法限制了对原发性脑肿胀的进一步研究。本研究比较了aSAH早期有和无原发性脑肿胀患者的脑容量变化率（CRBV）差异。此外，还评估了CRBV与临床结局之间的关系。本回顾性研究纳入了aSAH后24小时内入院的患者。利用研究前建立的定性标准，通过aSAH后的脑部CT识别原发性脑肿胀，采用改良Rankin量表（mRS）评估SAH 3个月后的临床结局。使用3D-slicer的半自动阈值算法计算每位患者的脑容量（BV），通过减去两个极值获得脑容量变化（CIBV）（CIBV = BV - BV）。CRBV通过CIBV/BV×100%获得。估计预测不良预后的CRBV值。本研究共纳入130名受试者。非肿胀组和肿胀组的平均CRBV分别为4.37%（±4.77）和11.87%（±6.84）（P<0.05）。CRBV与住院时间、环池积血、侧脑室积血和侧脑室容积呈正相关（Spearman相关系数ρ = 0.334；P<0.001；Pearson相关系数ρ = 0.269，P = 0.002；Pearson相关系数ρ = 0.278，P = 0.001；Pearson相关系数ρ = 0.233，P = 0.008）。方差分析显示，不同改良Fisher分级（mFisher）的CIBV、CRBV、环池积血、侧脑室积血和侧脑室容积存在显著差异，入院时mFisher分级越高，这些变量的值越大。在调整风险因素后，模型显示CRBV每增加1%，临床预后不良的概率增加1.236倍（95%CI = 1.056 - 1.446）。在分层分析中，随着CRBV的增加，临床结局恶化的几率增加。受试者工作特征曲线分析显示，Hunt-Hess分级、mFisher分级和CRBV评分（SCRBV）对预测不良临床结局具有诊断性能。原发性脑肿胀会使aSAH后脑容量增加。通过3D-Slicer量化的CRBV可作为脑肿胀程度的容积表示。aSAH早期较大的CRBV与预后不良相关。CRBV可作为出血后脑损伤的神经影像学生物标志物，可能是患者临床预后的有效预测指标。
