自发性急性脑出血患者颅内海绵状畸形的早期检测。

Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas.

机构信息

From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)

Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France.

出版信息

AJNR Am J Neuroradiol. 2023 Jul;44(7):807-813. doi: 10.3174/ajnr.A7914. Epub 2023 Jun 29.

DOI:10.3174/ajnr.A7914

PMID:37385679

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10337618/

Abstract

BACKGROUND AND PURPOSE

Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas.

MATERIALS AND METHODS

Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample.

RESULTS

Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (< .001), regular margins ( = .009), absence of extralesional hemorrhage ( = .01), and absence of peripheral rim enhancement ( = .002). These criteria were included in the decision tree model. The validation sample ( = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%).

CONCLUSIONS

An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.

摘要

背景与目的

早期明确自发性急性脑出血的病因对于恰当的治疗至关重要。本研究旨在建立一种影像学模型，以识别海绵状血管畸形相关的血肿。

材料与方法

纳入年龄在 1-55 岁之间、急性（≤7 天）自发性脑出血患者。2 名神经放射科医生回顾了 CT 和 MR 成像数据，并评估了血肿的特征，包括其形状（球形/卵圆形或非球形）、边缘规则或不规则，以及相关的异常，包括外出血和周围边缘强化。影像学表现与病因相关。研究人群随机分为训练样本（50%）和验证样本（50%）。从训练样本中，进行单变量和多变量逻辑回归以确定预测海绵状血管畸形的因素，并建立决策树。使用验证样本评估其性能。

结果

共纳入 478 例患者，其中 85 例为出血性海绵状血管畸形。多变量分析显示，海绵状血管畸形相关的血肿与球形/卵圆形形状（<0.001）、边缘规则（=0.009）、无外出血（=0.01）和无周围边缘强化（=0.002）相关。这些标准被纳入决策树模型。验证样本（=239）具有以下性能：诊断准确性为 96.1%（95%置信区间，92.2%-98.4%）、敏感度为 97.95%（95%置信区间，95.8%-98.9%）、特异性为 89.5%（95%置信区间，75.2%-97.0%）、阳性预测值为 97.7%（95%置信区间，94.3%-99.1%）和阴性预测值为 94.4%（95%置信区间，81.0%-98.5%）。