Kang Kaijiang, Ji Zeqiang, Du Yang, Li Guangshuo, Yan Jing, Ding Zeyu, Shi Yiming, Liu Yanfang, Wu Jianwei, Zhao Xingquan
From the Department of Neurology (K.K., Z.J., Y.D., G.L., J.Y., Z.D., Y.S., Y.L., J.W., X.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases (K.K., Z.J., Y.D., G.L., J.Y., Z.D., Y.S., Y.L., J.W., X.Z.), Beijing, China.
AJNR Am J Neuroradiol. 2025 Jul 1;46(7):1360-1366. doi: 10.3174/ajnr.A8680.
Postoperative rebleeding is a critical factor associated with poor outcomes in patients with intracerebral hemorrhage (ICH) who undergo minimally invasive catheter evacuation (MICE) followed by thrombolysis. This study aimed to explore the association between quantitative shape irregularity and density heterogeneity of preoperative hematoma and rebleeding after MICE.
We analyzed patients with ICH who underwent MICE between February 2021 and January 2024. The surface regularity index (SRI) and density coefficient of variation (DCV) of the hematomas were obtained based on preoperative CT by using 3D Slicer software. Postoperative rebleeding was defined as a hematoma increase of >6 mL or >33% compared with the previous CT. The predictive value of shape irregularity (reflected by SRI) and density heterogeneity (reflected by DCV) for postoperative rebleeding were comprehensively analyzed.
In total, 240 patients were included, of whom 45 (18.8%) experienced postoperative rebleeding. Patients with postoperative rebleeding exhibited lower SRI (37.2 versus 51.4, = .001) and higher DCV (13.8% versus 11.7%, < .001) after adjusting for preoperative hematoma volume, surface area, standard deviation of hematoma density, intraventricular hemorrhage (IVH), hematoma expansion (HE), time period from onset to surgery, and catheter misplacement. The combination of SRI, DCV, IVH, and HE demonstrated optimal discrimination in predicting postoperative rebleeding, with an area under the curve (AUC) and 95% CI of 0.880 (0.824-0.935).
Hematoma shape irregularity and density heterogeneity are risk factors for rebleeding after MICE for ICH. SRI and DCV can be used to identify individuals at high risk of postoperative rebleeding.
术后再出血是接受微创导管引流（MICE）并溶栓治疗的脑出血（ICH）患者预后不良的关键因素。本研究旨在探讨术前血肿的定量形状不规则性和密度异质性与MICE术后再出血之间的关联。
我们分析了2021年2月至2024年1月期间接受MICE治疗的ICH患者。使用3D Slicer软件基于术前CT获得血肿的表面规则性指数（SRI）和密度变异系数（DCV）。术后再出血定义为与上一次CT相比血肿增加>6 mL或>33%。综合分析形状不规则性（由SRI反映）和密度异质性（由DCV反映）对术后再出血的预测价值。
共纳入240例患者，其中45例（18.8%）发生术后再出血。在校正术前血肿体积、表面积、血肿密度标准差、脑室内出血（IVH）、血肿扩大（HE）、发病至手术的时间以及导管误置后，术后再出血患者的SRI较低（37.2对51.4，P = 0.001），DCV较高（13.8%对11.7%，P < 0.001）。SRI、DCV、IVH和HE的组合在预测术后再出血方面表现出最佳的辨别能力，曲线下面积（AUC）和95%可信区间为0.880（0.824 - 0.935）。
血肿形状不规则性和密度异质性是ICH患者MICE术后再出血的危险因素。SRI和DCV可用于识别术后再出血高风险个体。
