血肿表面不规则性可预测微创术后自发性脑出血患者的术后再出血及引流不畅：一项在大型卒中中心进行的回顾性队列研究
Hematoma surface irregularity predicts postoperative rebleeding and poor drainage in patients with spontaneous intracerebral hemorrhage following minimally invasive surgery: a retrospective cohort study at a high-volume stroke center.
作者信息
Ji Zeqiang, Kang Kaijiang, Du Yang, Hao Yunyi, Shi Yiming, Li Guangshuo, Wen Xinyu, Chen Xinlei, Ding Zeyu, Wu Jianwei, Zhao Xingquan
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
出版信息
Quant Imaging Med Surg. 2024 Dec 5;14(12):8889-8898. doi: 10.21037/qims-24-1105. Epub 2024 Nov 29.
BACKGROUND
The surface regularity index (SRI) reflects hematoma surface regularity in patients with intracerebral hemorrhage (ICH). Studies had reported an association between hematoma surface irregularity and hematoma expansion (HE). However, research on the correlation between the SRI and clinical outcomes in ICH patients following minimally invasive surgery (MIS) is limited. This study aimed to investigate the ability of the SRI to predict rebleeding and poor drainage in patients with spontaneous ICH following MIS.
METHODS
The data of patients with ICH who underwent MIS between January 2021 to September 2022 at Beijing Tiantan Hospital, a high-volume stroke center, were retrospectively analyzed. The clinical, radiological, and surgical characteristics of the patients were systematically reviewed. The hematoma were segmented and constructed, and the SRI scores were estimated using image-processing software [three-dimensional (3D) Slicer] based on preoperative computed tomography (CT) scans. Univariate and logistic regression analyses were conducted to identify potential predictors for post-MIS rebleeding and poor drainage (defined as a residual hematoma >15 mL).
RESULTS
A total of 151 ICH patients were included in the study, of whom 28 (18.5%) experienced post-MIS rebleeding, and 75 (49.7%) had poor drainage. The SRI was found to be independently associated with rebleeding [odds ratio (OR): 0.926, 95% confidence interval (CI): 0.891-0.963; P<0.001] and poor drainage (OR: 0.912, 95% CI: 0.882-0.944; P<0.001) after adjusting for confounders in the logistic regression. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve of the SRI in predicting postoperative rebleeding was 0.765 (the cut-off point, sensitivity, and specificity were 44.980, 66.7%, and 82.1%, respectively), and that for poor drainage was 0.809 (the cut-off point, sensitivity, and specificity were 53.462, 61.8%, and 89.3%, respectively).
CONCLUSIONS
The hematoma SRI is an independent indicator of postoperative rebleeding and poor drainage in ICH patients following MIS.
背景
表面规则指数（SRI）反映脑出血（ICH）患者血肿表面的规则性。研究报告称血肿表面不规则与血肿扩大（HE）之间存在关联。然而，关于SRI与微创外科手术（MIS）后ICH患者临床结局之间相关性的研究有限。本研究旨在探讨SRI预测自发性ICH患者MIS后再出血和引流不畅的能力。
方法
回顾性分析2021年1月至2022年9月期间在北京天坛医院（一家大型卒中中心）接受MIS的ICH患者的数据。系统回顾了患者的临床、影像学和手术特征。对血肿进行分割和构建，并基于术前计算机断层扫描（CT）扫描，使用图像处理软件[三维（3D）切片器]估算SRI评分。进行单因素和逻辑回归分析，以确定MIS后再出血和引流不畅（定义为残余血肿>15 mL）的潜在预测因素。
结果
本研究共纳入151例ICH患者，其中28例（18.5%）在MIS后发生再出血，75例（49.7%）引流不畅。在逻辑回归中对混杂因素进行校正后，发现SRI与再出血[比值比（OR）：0.926，95%置信区间（CI）：0.891 - 0.963；P<0.001]和引流不畅（OR：0.912，95%CI：0.882 - 0.944；P<0.001）独立相关。SRI预测术后再出血的受试者工作特征（ROC）曲线下面积（AUC）为0.765（截断点、灵敏度和特异度分别为44.980、66.7%和82.1%），预测引流不畅的AUC为0.809（截断点、灵敏度和特异度分别为53.462、61.8%和89.3%）。
结论
血肿SRI是ICH患者MIS后术后再出血和引流不畅的独立指标。
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