Abou Karam Gaby, Chen Min-Chiun, Zeevi Dorin, Harms Bendix C, Berson Elisa, Torres-Lopez Victor M, Rivier Cyprien A, Malhotra Ajay, Qureshi Adnan I, Falcone Guido J, Sheth Kevin N, Payabvash Seyedmehdi
Department of Radiology and Biomedical Imaging (G.A.K., M.-C.C., D.Z., B.C.H., E.B., A.M., S.P.), Yale University School of Medicine, New Haven, CT.
Department of Neurology (V.M.T.-L., C.A.R., G.J.F., K.N.S.), Yale University School of Medicine, New Haven, CT.
Stroke. 2025 Apr;56(4):868-877. doi: 10.1161/STROKEAHA.124.048453. Epub 2025 Mar 7.
Prior studies on the clinical impact of intracerebral hemorrhage (ICH) location have used visual localization of hematomas to neuroanatomical structures. However, hematomas often cross neuroanatomical structure boundaries with inter-reviewer variability in visual localization. To address these limitations, we applied voxel-wise analysis to identify brain regions where ICH presence is independently predictive of worse outcomes.
We included consecutive patients with acute spontaneous ICH from a comprehensive stroke center in a derivation cohort and validated the results in patients from the control arm of a multicenter clinical trial. Using general linear models, we created and publicly shared a voxel-wise map of brain regions where ICH presence was associated with higher 3-month modified Rankin Scale scores, independent of hematoma volume and clinical risk factors. We also determined the optimal overlap threshold between baseline hematoma and voxel-wise map to categorize ICH location into high versus low risk.
Excluding those with missing variables, head computed tomography processing pipeline failure and poor scan quality, 559 of 780 patients were included in derivation (mean age, 69.3±14.5 years; 311 [55.6%] males) and 345 of 500 (mean age, 62.5±12.9 years; 206 [59.7%] males) in validation cohorts. In a voxel-wise analysis, ICH presence in deep white matter, thalami, caudate, midbrain, and pons was associated with worse outcomes. At the patient level, >22% overlap of baseline hematoma with voxel-wise map optimally binarized ICH location to high- versus low-risk categories. In both the derivation and validation cohorts, a high-risk ICH location was independently associated with worse outcomes (higher 3-month modified Rankin Scale score), after adjusting for patients' age, symptom severity at admission, baseline hematoma volume, and the presence of intraventricular hemorrhage, with adjusted odds ratios of 2 ([95% CI, 1.3-3.0] =0.001) and 1.7 ([95% CI, 1.1-2.9] =0.027), respectively.
We created and publicly shared a voxel-wise map of brain regions where hematoma presence predicts worse outcomes, independent of volume and clinical risk factors.
既往关于脑出血（ICH）部位临床影响的研究采用血肿在神经解剖结构上的视觉定位。然而，血肿常跨越神经解剖结构边界，且不同审阅者的视觉定位存在差异。为解决这些局限性，我们采用体素分析来识别脑出血存在时独立预测不良预后的脑区。
我们纳入了来自一个综合卒中中心的急性自发性脑出血连续患者作为推导队列，并在一项多中心临床试验的对照组患者中验证了结果。使用一般线性模型，我们创建并公开分享了一个脑区的体素图，其中脑出血的存在与3个月改良Rankin量表评分较高相关，且独立于血肿体积和临床危险因素。我们还确定了基线血肿与体素图之间的最佳重叠阈值，以将脑出血部位分为高风险和低风险。
排除变量缺失、头部计算机断层扫描处理流程失败和扫描质量差的患者后，推导队列纳入了780例患者中的559例（平均年龄69.3±14.5岁；311例[55.6%]为男性），验证队列纳入了500例患者中的345例（平均年龄62.5±12.9岁；206例[59.7%]为男性）。在体素分析中，深部白质、丘脑、尾状核、中脑和脑桥中存在脑出血与不良预后相关。在患者层面，基线血肿与最佳二值化体素图的重叠>22%可将脑出血部位最佳地分为高风险和低风险类别。在推导队列和验证队列中，调整患者年龄、入院时症状严重程度、基线血肿体积和脑室内出血的存在后，高风险脑出血部位均与不良预后独立相关（3个月改良Rankin量表评分更高），调整后的比值比分别为2（[95%CI，1.3 - 3.0]=0.001）和1.7（[95%CI，1.1 - 2.9]=0.027）。
我们创建并公开分享了一个脑区的体素图，其中血肿的存在可预测不良预后，且独立于体积和临床危险因素。
