Xu Tianqi, Yang Jianhong, Han Qing, Wu Yuefei, Gao Xiang, Xu Yao, Huang Yi, Wang Aiju, Parsons Mark W, Lin Longting
Department of Neurology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China.
Department of Neurosurgery, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, China.
Front Neurol. 2022 Jul 27;13:903263. doi: 10.3389/fneur.2022.903263. eCollection 2022.
We hypothesized that quantitative net water uptake (NWU), a novel neuroimaging marker of early brain edema, can predict symptomatic intracranial hemorrhage (sICH) after acute ischemic stroke (AIS).
We enrolled patients with AIS who completed admission multimodal computed tomography (CT) within 24 h after stroke onset. NWU within the ischemic core and penumbra was calculated based on admission CT, namely NWU-core and NWU-penumbra. sICH was defined as the presence of ICH in the infarct area within 7 days after stroke onset, accompanied by clinical deterioration. The predictive value of NWU-core and NWU-penumbra on sICH was evaluated by logistic regression analyses and the receiver operating characteristic (ROC) curve. A pure neuroimaging prediction model was built considering imaging markers, which has the potential to be automatically quantified with an artificial algorithm on image workstation.
154 patients were included, of which 93 underwent mechanical thrombectomy (MT). The median time from symptom onset to admission CT was 262 min (interquartile range, 198-368). In patients with MT, NWU-penumbra (OR =1.442; 95% CI = 1.177-1.766; < 0.001) and NWU-core (OR = 1.155; 95% CI = 1.027-1.299; = 0.016) were independently associated with sICH with adjustments for age, sex, time from symptom onset to CT, hypertension, lesion volume, and admission National Institutes of Health Stroke Scale (NIHSS) score. ROC curve showed that NWU-penumbra had better predictive performance than NWU-core on sICH [area under the curve (AUC): 0.773 vs. 0.673]. The diagnostic efficiency of the predictive model was improved with the containing of NWU-penumbra (AUC: 0.853 vs. 0.760). A pure imaging model also presented stable predictive power (AUC = 0.812). In patients without MT, however, only admission NIHSS score (OR = 1.440; 95% CI = 1.055-1.965; = 0.022) showed significance in predicting sICH in multivariate analyses.
NWU-penumbra may have better predictive performance than NWU-core on sICH after MT. A pure imaging model showed potential value to automatically screen patients with sICH risk by image recognition, which may optimize treatment strategy.
我们假设定量净吸水量（NWU）作为早期脑水肿的一种新型神经影像标志物，能够预测急性缺血性卒中（AIS）后有症状性颅内出血（sICH）的发生。
我们纳入了在卒中发作后24小时内完成入院多模态计算机断层扫描（CT）的AIS患者。根据入院CT计算缺血核心区和半暗带内的NWU，即NWU-核心区和NWU-半暗带。sICH定义为卒中发作后7天内梗死区域出现颅内出血，并伴有临床病情恶化。通过逻辑回归分析和受试者工作特征（ROC）曲线评估NWU-核心区和NWU-半暗带对sICH的预测价值。构建了一个考虑影像标志物的纯神经影像预测模型，该模型有可能在图像工作站上通过人工算法自动量化。
共纳入154例患者，其中93例行机械取栓术（MT）。从症状发作到入院CT的中位时间为262分钟（四分位间距，198 - 368）。在接受MT的患者中，对年龄、性别、从症状发作到CT的时间、高血压、病变体积和入院时美国国立卫生研究院卒中量表（NIHSS）评分进行校正后，NWU-半暗带（OR = 1.442；95%可信区间 = 1.177 - 1.766；P < 0.001）和NWU-核心区（OR = 1.155；95%可信区间 = 1.027 - 1.299；P = 0.016）与sICH独立相关。ROC曲线显示，NWU-半暗带对sICH的预测性能优于NWU-核心区[曲线下面积（AUC）：0.773对0.673]。包含NWU-半暗带的预测模型诊断效率提高（AUC：0.853对0.760）。一个纯影像模型也呈现出稳定的预测能力（AUC = 0.812）。然而，在未接受MT的患者中，多因素分析显示仅入院时NIHSS评分（OR = 1.440；95%可信区间 = 1.055 - 1.965；P = 0.022）在预测sICH方面具有显著性。
在MT后，NWU-半暗带对sICH的预测性能可能优于NWU-核心区。一个纯影像模型显示出通过图像识别自动筛查有sICH风险患者的潜在价值，这可能优化治疗策略。
