Huang Zhenshan, Qian Feng, Ma Kui, Jiang Guowei, Zhang Lianfu, Zhang Yongming
Department of Neurosurgery, Anhui No. 2 Provincial People's Hospital, Hefei, Anhui, China.
Anhui Medical University, Hefei, Anhui, China.
Front Neurol. 2025 Jan 8;15:1490957. doi: 10.3389/fneur.2024.1490957. eCollection 2024.
This study aims to investigate the effects of preoperative intracerebral hematoma volume (HVpre), hematoma volume 6-8 days post-surgery (HVpost), and the rate of hematoma volume change (HVpre-HVpost)/HVpre on the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH).
CT imaging data from 62 aSAH patients admitted to our hospital's Neurosurgery Department between January 2022 and December 2023 were obtained, both preoperatively and 6-8 days postoperatively. The hematoma volumes were measured using 3D-Slicer. Patients' recovery at 3 months post-discharge was assessed using the Modified Rankin Scale (mRS), categorizing the patients into a good prognosis group (mRS score 1-2) and a poor prognosis group (mRS score 3-5). Multivariate logistic regression analysis was conducted to identify independent risk factors for poor prognosis. Statistical methods were employed to compare preoperative and postoperative hematoma volumes with commonly used clinical scores. The predictive value of HVpre and HVpost for poor prognosis was evaluated using ROC curves. The rate of volume change was stratified by interquartile ranges, and the impact of different change rates on prognosis was compared.
Significant differences were found between good and poor prognosis groups in age, GCS score, Hunt-Hess grade, mFisher grade, BVpre, BVpost, and (HVpre-HVpost)/HVpre ( < 0.05). Logistic regression identified gender, age, BVpre, BVpost, and volume change rate as independent risk factors ( < 0.01). Increased GCS scores and higher Hunt-Hess and mFisher grades correlated with increased HVpre and HVpost. Higher hemorrhage reduction rates were linked to better outcomes. ROC curves showed HVpre and HVpost AUC values (0.831 and 0.857, respectively) were significantly higher than clinical scales. An HVpre volume over 22.25 mL and HVpost over 15.67 mL indicated a higher risk of poor prognosis, with sensitivities of 79.3 and 80.7%, and specificities of 67.1 and 69.3%.
HVpre, HVpost, and (HVpre-HVpost)/HVpre can serve as neuroimaging biomarkers for assessing patients after aSAH and can effectively predict clinical prognosis.
本研究旨在探讨术前脑内血肿体积（HVpre）、术后6 - 8天血肿体积（HVpost）以及血肿体积变化率（HVpre - HVpost）/HVpre对动脉瘤性蛛网膜下腔出血（aSAH）患者预后的影响。
获取我院神经外科2022年1月至2023年12月收治的62例aSAH患者术前及术后6 - 8天的CT影像数据。采用3D-Slicer测量血肿体积。出院后3个月时，使用改良Rankin量表（mRS）评估患者恢复情况，将患者分为预后良好组（mRS评分1 - 2分）和预后不良组（mRS评分3 - 5分）。进行多因素逻辑回归分析以确定预后不良的独立危险因素。采用统计学方法比较术前和术后血肿体积与常用临床评分。使用ROC曲线评估HVpre和HVpost对预后不良的预测价值。将体积变化率按四分位数间距分层，比较不同变化率对预后的影响。
预后良好组与预后不良组在年龄、GCS评分、Hunt-Hess分级、mFisher分级、BVpre、BVpost以及（HVpre - HVpost）/HVpre方面存在显著差异（<0.05）。逻辑回归确定性别、年龄、BVpre、BVpost和体积变化率为独立危险因素（<0.01）。GCS评分升高以及Hunt-Hess和mFisher分级越高与HVpre和HVpost增加相关。更高的血肿减少率与更好的预后相关。ROC曲线显示HVpre和HVpost的AUC值（分别为0.831和0.857）显著高于临床量表。HVpre体积超过22.25 mL且HVpost超过15.67 mL表明预后不良风险较高，敏感性分别为79.3%和80.7%，特异性分别为67.1%和69.3%。
HVpre、HVpost以及（HVpre - HVpost）/HVpre可作为评估aSAH患者的神经影像生物标志物，并能有效预测临床预后。
