Vyas Vedang, Savitz Sean I, Boren Seth B, Becerril-Gaitan Andrea, Hasan Khader, Suchting Robert, deDios Constanza, Solberg Spencer, Chen Ching-Jen, Brown Robert J, Sitton Clark W, Grotta James, Aronowski Jaroslaw, Gonzales Nicole, Haque Muhammad E
Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA.
Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Neurocrit Care. 2025 Feb;42(1):48-58. doi: 10.1007/s12028-024-02070-7. Epub 2024 Jul 31.
We developed a noninvasive biomarker to quantify the rate of ventricular blood clearance in patients with intracerebral hemorrhage and extension to the ventricles-intraventricular hemorrhage.
We performed magnetic resonance imaging in 26 patients at 1, 14, 28, and 42 days of onset and measured their hematoma volume (HV), ventricular blood volume (VBV), and two diffusion metrics: fractional anisotropy (FA), and mean diffusivity (MD). The ipasilesional ventricular cerebral spinal fluid's FA and MD were associated with VBV and stroke severity scores (National Institute of Health Stroke Scale [NIHSS]). A subcohort of 14 patients were treated with external ventricular drain (EVD). A generalized linear mixed model was applied for statistical analysis.
At day 1, the average HVs and NIHSS scores were 14.6 ± 16.7 cm and 16 ± 8, respectively. A daily rate of 2.1% and 1.3% blood clearance/resolution were recorded in HV and VBV, respectively. Ipsilesional ventricular FA (vFA) and ventricular MD (vMD) were simultaneously decreased (vFA = 1.3% per day, posterior probability [PP] > 99%) and increased (vMD = 1.5% per day, PP > 99%), respectively. Patients with EVD exhibited a faster decline in vFA (1.5% vs. 1.1% per day) and an increase in vMD (1.8% vs. 1.5% per day) as compared with patients without EVD. Temporal change in vMD was associated with VBV; a 1.00-cm increase in VBV resulted in a 5.2% decrease in vMD (PP < 99%). VBV was strongly associated with NIHSS score (PP = 97-99%). A larger cerebral spinal fluid drained volume was associated with a greater decrease (PP = 83.4%) in vFA, whereas a smaller volume exhibited a greater increase (PP = 94.8%) in vMD.
In conclusion, vFA and vMD may serve as biomarkers for VBV status.
我们开发了一种非侵入性生物标志物，用于量化脑出血并延伸至脑室（即脑室内出血）患者的心室血液清除率。
我们对26例患者在发病1天、14天、28天和42天时进行了磁共振成像，并测量了他们的血肿体积（HV）、脑室血量（VBV）以及两个扩散指标：分数各向异性（FA）和平均扩散率（MD）。患侧脑室脑脊液的FA和MD与VBV及卒中严重程度评分（美国国立卫生研究院卒中量表[NIHSS]）相关。14例患者的亚组接受了脑室外引流（EVD）治疗。应用广义线性混合模型进行统计分析。
在第1天，平均HV和NIHSS评分分别为14.6±16.7 cm和16±8。HV和VBV的每日血液清除/消退率分别记录为2.1%和1.3%。患侧脑室FA（vFA）和脑室MD（vMD）分别同时下降（vFA = 每天1.3%，后验概率[PP]>99%）和上升（vMD = 每天1.5%，PP>99%）。与未接受EVD的患者相比，接受EVD的患者vFA下降更快（每天1.5%对1.1%），vMD上升更快（每天1.8%对1.5%）。vMD的时间变化与VBV相关；VBV每增加1.00 cm，vMD下降5.2%（PP<99%）。VBV与NIHSS评分密切相关（PP = 97 - 99%）。更大的脑脊液引流量与vFA更大幅度的下降相关（PP = 83.4%），而更小的引流量则与vMD更大幅度的上升相关（PP = 94.8%）
总之，vFA和vMD可作为VBV状态的生物标志物。
