Li Ying, Zhang Zhuangzhuang, Li Jieyu, Sun Weiping, Wang Zhaoxia, Huang Yining
Department of Neurology, Peking University First Hospital, Beijing, China.
Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):6854-6862. doi: 10.21037/qims-23-266. Epub 2023 Sep 18.
Intraventricular hemorrhage (IVH) after intracerebral hemorrhage (ICH) is a strong independent predictor of poor outcomes. Although the location and volume of ICH are associated with IVH, our knowledge concerning the mechanism of IVH after ICH is still limited. This study aimed to investigate the relationship between hematoma morphology and IVH in patients with supratentorial deep ICH.
We retrospectively analyzed adult patients (aged ≥18 years) with spontaneous supratentorial deep ICH who underwent computed tomography (CT) within 48 h after ICH symptom onset in Peking University First Hospital between January 2017 and August 2022. We collected the clinical and imaging data of the patients and assessed hematoma morphology using several quantitative radiological parameters including hematoma volume, sphericity index, A/B ratio (A: the largest area of hematoma; B: the largest diameter 90° to A on the same slice), and our newly proposed largest diameter-midline angle (LMA). Multivariable logistic regression analysis was used to analyze the relationship between these parameters and the presence of IVH on the initial CT scan.
Among 114 patients with spontaneous supratentorial deep ICH, 41 (36.0%) had IVH. In patients with IVH, the sphericity index was lower than that in individuals without IVH, while the LMA was larger. Multivariate logistic regression analysis showed that sphericity index [0.1-unit odds ratio (OR) =0.252; 95% CI: 0.089-0.709; P=0.009] and the LMA (10-unit OR =1.281; 95% CI: 1.007-1.630; P=0.04) were independently associated with the presence of IVH in patients with supratentorial deep ICH. Univariate analyses showed that hematoma volume, A/B ratio, sphericity index, and the LMA were significantly associated with poor outcomes at discharge.
Two quantitative parameters of hematoma morphology, sphericity index and the LMA, were significantly associated with the presence of IVH in patients with supratentorial deep ICH. Further prospective studies with larger sample sizes are needed to validate our results.
脑出血（ICH）后的脑室内出血（IVH）是不良预后的一个强有力的独立预测因素。尽管ICH的位置和体积与IVH有关，但我们对ICH后IVH机制的了解仍然有限。本研究旨在探讨幕上深部ICH患者血肿形态与IVH之间的关系。
我们回顾性分析了2017年1月至2022年8月期间在北京大学第一医院因自发性幕上深部ICH症状发作后48小时内接受计算机断层扫描（CT）的成年患者（年龄≥18岁）。我们收集了患者的临床和影像数据，并使用血肿体积、球形指数、A/B比值（A：血肿最大面积；B：同一层面上与A呈90°的最大直径）以及我们新提出的最大直径-中线角（LMA）等几个定量放射学参数评估血肿形态。采用多变量逻辑回归分析来分析这些参数与初始CT扫描时IVH存在之间的关系。
在114例自发性幕上深部ICH患者中，41例（36.0%）发生了IVH。发生IVH的患者球形指数低于未发生IVH的患者，而LMA更大。多变量逻辑回归分析显示，球形指数[0.1单位比值比（OR）=0.252；95%置信区间：0.089-0.709；P=0.009]和LMA（10单位OR =1.281；95%置信区间：1.007-1.630；P=0.04）与幕上深部ICH患者IVH的存在独立相关。单变量分析显示，血肿体积、A/B比值、球形指数和LMA与出院时的不良预后显著相关。
血肿形态的两个定量参数，即球形指数和LMA，与幕上深部ICH患者IVH的存在显著相关。需要进一步进行更大样本量的前瞻性研究来验证我们的结果。
