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基于MRI的脑小血管病负担对脑出血不良预后预测的附加价值

Added Value of Cerebral Small Vascular Disease Burden Based On MRI for Prediction Poor Outcome of Intracerebral Hemorrhage.

作者信息

Wang Sihui, Zhang Yingjie, Wang Xiaochen, Li Hongwei, Zhao Xuening, Chen Lingxu, Yuan Mengyuan, Ju Yi, Sun Shengjun

机构信息

Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Department of Radiology, Beijing Neurosurgical Institute, Beijing, China.

出版信息

Clin Neuroradiol. 2025 May 2. doi: 10.1007/s00062-025-01517-4.

Abstract

BACKGROUND

The significance between cerebral small vessel disease (CSVD) markers on MRI and clinical outcome in intracerebral hemorrhage (ICH) patients is unclear. This study aimed to explore the connection between CSVD markers and short-term outcome in ICH patients.

METHODS

We retrospectively included 318 ICH patients. Patients were categorized into unfavorable and favorable prognosis groups based on their 90-day modified Rankin Scale (mRS) score (mRS > 3 indicates unfavorable). We conducted an MRI-based assessment of CSVD markers and investigated the predictive power of individual markers and the overall burden on prognosis.

RESULTS

White matter hyperintensities (WMH) with a modified Fazekas score ≥ 2 (95% CI 2.367-17.421, p < 0.001), the presence of cortical superficial siderosis (CSS) (95 % CI 2.582-28.212, p < 0.001 in Model 1; 95 % CI 2.701-27.385, p < 0.001 in Model 2), and total CSVD burden (95 % CI 1.249-2.352, p < 0.05) are independent risk factors for unfavorable outcome of ICH.

CONCLUSIONS

MRI-based markers of CSVD are valuable in assessing the risk of poor outcome in ICH. WMH with a modified Fazekas score ≥ 2, the presence of CSS, and higher CSVD burden are independently associated with adverse functional outcome.

摘要

背景

脑出血(ICH)患者磁共振成像(MRI)上脑小血管病(CSVD)标志物与临床结局之间的关系尚不清楚。本研究旨在探讨CSVD标志物与ICH患者短期结局之间的联系。

方法

我们回顾性纳入了318例ICH患者。根据90天改良Rankin量表(mRS)评分将患者分为预后不良组和预后良好组(mRS>3表示预后不良)。我们基于MRI对CSVD标志物进行了评估,并研究了个体标志物和总体负担对预后的预测能力。

结果

改良Fazekas评分≥2的脑白质高信号(WMH)(95%CI 2.367-17.421,p<0.001)、皮质表面铁沉积(CSS)的存在(模型1中95%CI 2.582-28.212,p<0.001;模型2中95%CI 2.701-27.385,p<0.001)以及总的CSVD负担(95%CI 1.249-2.352,p<0.05)是ICH预后不良的独立危险因素。

结论

基于MRI的CSVD标志物在评估ICH预后不良风险方面具有重要价值。改良Fazekas评分≥2的WMH、CSS的存在以及更高的CSVD负担与不良功能结局独立相关。

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