1
|
Zhang SQ, Zhang YL, Yuan L, Ma YB, Huang JM, Wen YQ, Zhu MH, Yang WS. A comprehensive prediction model predicts perihematomal edema growth in the acute stage after intracerebral hemorrhage. Clin Neurol Neurosurg 2024; 245:108495. [PMID: 39126898 DOI: 10.1016/j.clineuro.2024.108495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/14/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Perihematomal edema (PHE) is regarded as a potential intervention indicator of secondary injury following intracerebral hemorrhage (ICH). But it still lacks a comprehensive prediction model for early PHE formation. METHODS The included ICH patients have received an initial Computed Tomography scan within 6 hours of symptom onset. Hematoma volume and PHE volume were computed using semiautomated computer-assisted software. The volume of the hematoma, edema around the hematoma, and surface area of the hematoma were calculated. The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte cell count. All analyses were 2-tailed, and the significance level was determined by P <0.05. RESULTS A total of 226 patients were included in the final analysis. The optimal cut-off values for PHE volume increase to predict poor outcomes were determined as 5.5 mL. For clinical applicability, we identified a value of 5.5 mL as the optimal threshold for early PHE growth. In the multivariate logistic regression analyses, we finally found that baseline hematoma surface area (p < 0.001), expansion-prone hematoma (p < 0.001), and PLR (p = 0.033) could independently predict PHE growth. The comprehensive prediction model demonstrated good performance in predicting PHE growth, with an area under the curve of 0.841, sensitivity of 0.807, and specificity of 0.732. CONCLUSION In this study, we found that baseline hematoma surface area, expansion-prone hematoma, and PLR were independently associated with PHE growth. Additionally, a risk nomogram model was established to predict the PHE growth in patients with ICH.
Collapse
Affiliation(s)
- Shu-Qiang Zhang
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan-Ling Zhang
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China
| | - Liang Yuan
- Department of Radiology, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Yong-Bo Ma
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun-Meng Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yi-Qian Wen
- Department of Radiology, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Ming-Hong Zhu
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China.
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| |
Collapse
|
2
|
Witsch J, Cao Q, Song JW, Luo Y, Sloane KL, Rothstein A, Favilla CG, Cucchiara BL, Kasner SE, Messé SR, Choi HA, McCullough LD, Mayer SA, Gusdon AM. Sex Differences in Perihematomal Edema Volume and Outcome After Intracerebral Hemorrhage. Neurocrit Care 2024; 41:208-217. [PMID: 38379104 DOI: 10.1007/s12028-024-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Although larger hematoma volume is associated with worse outcome after intracerebral hemorrhage (ICH), the association between perihematomal edema (PHE) volume and outcome remains uncertain, as does the impact of sex on PHE and outcome. Here we aimed to determine whether larger PHE volume is associated with worse outcome and whether PHE volume trajectories differ by sex. METHODS We conducted a post hoc analysis of the Factor VIIa for Acute Hemorrhagic Stroke Treatment (FAST) trial, which randomized patients with ICH to receive recombinant activated factor VIIa or placebo. Computerized planimetry calculated PHE and ICH volumes on serial computed tomography (CT) scans (at baseline [within 3 h of onset], at 24 h, and at 72 h). Generalized estimating equations examined interactions between sex, CT time points, and FAST treatment arm on PHE and ICH volumes. Mixed and multivariable logistic models examined associations between sex, PHE, and outcomes. RESULTS A total of 781 patients with supratentorial ICH (mean age 65 years) were included. Compared to women (n = 296), men (n = 485) had similar median ICH (14.9 vs. 13.6 mL, p = 0.053) and PHE volumes (11.1 vs. 10.5 mL, p = 0.56) at baseline but larger ICH and PHE volumes at 24 h (19.0 vs. 14.0 mL, p < 0.001; 22.2 vs. 15.7 mL, p < 0.001) and 72 h (16.0 vs. 11.8 mL, p < 0.001; 28.7 vs. 19.9 mL, p < 0.001). Men had higher absolute early PHE expansion (p < 0.001) and more hematoma expansion (growth ≥ 33% or 6 mL at 24 h, 33% vs. 22%, p < 0.001). An interaction between sex and CT time points on PHE volume (p < 0.001), but not on ICH volume, confirmed a steeper PHE trajectory in men. PHE expansion (per 5 mL, odds radio 1.19, 95% confidence interval 1.10-1.28), but not sex, was associated with poor outcome. CONCLUSIONS Early PHE expansion and trajectory in men were significantly higher. PHE expansion was associated with poor outcomes independent of sex. Mechanisms leading to sex differences in PHE trajectories merit further investigation.
Collapse
Affiliation(s)
- Jens Witsch
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Quy Cao
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yunshi Luo
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly L Sloane
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Aaron Rothstein
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Christopher G Favilla
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Brett L Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Scott E Kasner
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Steve R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Huimahn A Choi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Louise D McCullough
- Department of Neurobiology & Anatomy, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Aaron M Gusdon
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Neurobiology & Anatomy, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
3
|
Dierksen F, Tran AT, Zeevi T, Maier IL, Qureshi AI, Sanelli PC, Werring DJ, Malhotra A, Falcone GJ, Sheth KN, Payabvash S. Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage. Eur Stroke J 2024; 9:383-390. [PMID: 38179883 PMCID: PMC11318427 DOI: 10.1177/23969873231223814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Perihematomal edema (PHE) represents secondary brain injury and a potential treatment target in intracerebral hemorrhage (ICH). However, studies differ on optimal PHE volume metrics as prognostic factor(s) after spontaneous, non-traumatic ICH. This study examines associations of baseline and 24-h PHE shape features with 3-month outcomes. PATIENTS AND METHODS We included 796 patients from a multicentric trial dataset and manually segmented ICH and PHE on baseline and follow-up CTs, extracting 14 shape features. We explored the association of baseline, follow-up, difference (baseline/follow-up) and temporal rate (difference/time gap) of PHE shape changes with 3-month modified Rankin Score (mRS) - using Spearman correlation. Then, using multivariable analysis, we determined if PHE shape features independently predict outcome adjusting for patients' age, sex, NIH stroke scale (NIHSS), Glasgow Coma Scale (GCS), and hematoma volume. RESULTS Baseline PHE maximum diameters across various planes, main axes, volume, surface, and sphericity correlated with 3-month mRS adjusting for multiple comparisons. The 24-h difference and temporal change rates of these features had significant association with outcome - but not the 24-h absolute values. In multivariable regression, baseline PHE shape sphericity (OR = 2.04, CI = 1.71-2.43) and volume (OR = 0.99, CI = 0. 98-1.0), alongside admission NIHSS (OR = 0.86, CI = 0.83-0.88), hematoma volume (OR = 0.99, CI = 0. 99-1.0), and age (OR = 0.96, CI = 0.95-0.97) were independent predictors of favorable outcomes. CONCLUSION In acute ICH patients, PHE shape sphericity at baseline emerged as an independent prognostic factor, with a less spherical (more irregular) shape associated with worse outcome. The PHE shape features absolute values over the first 24 h provide no added prognostic value to baseline metrics.
Collapse
Affiliation(s)
- Fiona Dierksen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Anh T Tran
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ilko L Maier
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Pina C Sanelli
- Department of Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - David J Werring
- Stroke Research Centre, University College London, Queen Square Institute of Neurology, London, UK
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Seyedmehdi Payabvash
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage. Front Neurol 2024; 15:1359760. [PMID: 38645743 PMCID: PMC11026700 DOI: 10.3389/fneur.2024.1359760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59-79), median baseline ICH volume 11.5 (IQR 4.3-28.9) mL, and median baseline CRP 2.5 (IQR 1.5-7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000-0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90-1.05, p = 0.51 and HR 0.98; 95%CI 0.93-1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.
Collapse
Affiliation(s)
- Oluwaseun A. Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Isabel C. Hostettler
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Teddy Y. Wu
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Calvin Heal
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Duncan Wilson
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Darshan G. Shah
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andy Vail
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Gagan Sharma
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M. Davis
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David J. Werring
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Atte Meretoja
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Stuart M. Allan
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Adrian R. Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| |
Collapse
|
5
|
Tariq F, Jumah F, Ravipati K, Ortiz-Torres M, Carr SB, Chicoine MR. Advances in Cranial Surgery. MISSOURI MEDICINE 2024; 121:136-141. [PMID: 38694609 PMCID: PMC11057866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The landscape of the cranial neurosurgery has changed tremendously in past couple of decades. The main frontiers including introduction of neuro-endoscopy, minimally invasive skull base approaches, SRS, laser interstitial thermal therapy and use of tubular retractors have revolutionized the management of intracerebral hemorrhages, deep seated tumors other intracranial pathologies. Introduction of these novel techniques is based on smaller incisions with maximal operative corridors, decreased blood loss, shorter hospital stays, decreased post-operative pain and cosmetically appealing scars that improves patient satisfaction and clinical outcomes. The sophisticated tools like neuroendoscopy have improved light source, and better visualization around the corners. Advanced navigated tools and channel-based retractors help us to target deeply seated lesions with increased precision and minimal disruption of the surrounding neurovascular tissues. Advent of stereotactic radiosurgery has provided us alternative feasible, safe and effective options for treatment of patients who are otherwise not medically stable to undergo complex cranial surgical interventions. This paper review advances in treatment of intracranial pathologies, and how the neurosurgeons and other medical providers at the University of Missouri-Columbia (UMC) are optimizing these treatments for their patients.
Collapse
Affiliation(s)
- Farzana Tariq
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Fareed Jumah
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Kaushik Ravipati
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Michael Ortiz-Torres
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Steven B Carr
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Michael R Chicoine
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| |
Collapse
|
6
|
Krawchuk LJ, Sharrock MF. Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury. Semin Neurol 2023; 43:699-711. [PMID: 37802120 DOI: 10.1055/s-0043-1775790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.
Collapse
Affiliation(s)
- Lindsey J Krawchuk
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew F Sharrock
- Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
7
|
Chen Y, Jiang C, Chang J, Qin C, Zhang Q, Ye Z, Li Z, Tian F, Ma W, Feng M, Wei J, Yao J, Wang R. An artificial intelligence-based prognostic prediction model for hemorrhagic stroke. Eur J Radiol 2023; 167:111081. [PMID: 37716178 DOI: 10.1016/j.ejrad.2023.111081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The prognosis following a hemorrhagic stroke is usually extremely poor. Rating scales have been developed to predict the outcomes of patients with intracerebral hemorrhage (ICH). To date, however, the prognostic prediction models have not included the full range of relevant imaging features. We constructed a clinic-imaging fusion model based on convolutional neural networks (CNN) to predict the short-term prognosis of ICH patients. MATERIALS AND METHODS This was a multi-center retrospective study, which included 1990 patients with ICH. Two CNN-based deep learning models were constructed to predict the neurofunctional outcomes at discharge; these were validated using a nested 5-fold cross-validation approach. The models' predictive efficiency was compared with the original ICH scale and the ICH grading scale. Poor neurological outcome was defined as a Glasgow Outcome Scale (GOS) score of 1-3. RESULTS The training and test sets included 1599 and 391 patients, respectively. For the test set, the clinic-imaging fusion model had the highest area under the curve (AUC = 0.903), followed by the imaging-based model (AUC = 0.886), the ICH scale (AUC = 0.777), and finally the ICH grading scale (AUC = 0.747). CONCLUSION The CNN prognostic prediction model based on neuroimaging features was more effective than the ICH scales in predicting the neurological outcomes of ICH patients at discharge. The CNN model's predictive efficiency slightly improved when clinical data were included.
Collapse
Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Qinghua Zhang
- Department of Neurosurgery, Shenzhen Nanshan Hospital, Shen Zhen, China
| | - Zeju Ye
- Department of Neurosurgery, Dongguan People's Hospital, Guangdong Province, China
| | - Zhaojian Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, China; Department of Medicine, Qingdao University, Qingdao, China
| | - Fengxuan Tian
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Qinghai Province, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | | | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
8
|
Huang X, Wang D, Ma Y, Zhang Q, Ren J, Zhao H, Li S, Deng J, Yang J, Zhao Z, Xu M, Zhou Q, Zhou J. Perihematomal edema-based CT-radiomics model to predict functional outcome in patients with intracerebral hemorrhage. Diagn Interv Imaging 2023; 104:391-400. [PMID: 37179244 DOI: 10.1016/j.diii.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to identify possible association between noncontrast computed tomography (NCCT)-based radiomics features of perihematomal edema (PHE) and poor functional outcome at 90 days after intracerebral hemorrhage (ICH) and to develop a NCCT-based radiomics-clinical nomogram to predict 90-day functional outcomes in patients with ICH. MATERIALS AND METHODS In this multicenter retrospective study, 107 radiomics features were extracted from 1098 NCCT examinations obtained in 1098 patients with ICH. There were 652 men and 446 women with a mean age of 60 ± 12 (SD) years (range: 23-95 years). After harmonized and univariable and multivariable screening, seven of these radiomics features were closely associated with the 90-day functional outcome of patients with ICH. The radiomics score (Rad-score) was calculated based on the seven radiomics features. A clinical-radiomics nomogram was developed and validated in three cohorts. The model performance was evaluated using area under the curve analysis and decision and calibration curves. RESULTS Of the 1098 patients with ICH, 395 had a good outcome at 90 days. Hematoma hypodensity sign and intraventricular and subarachnoid hemorrhages were identified as risk factors for poor outcomes (P < 0.001). Age, Glasgow coma scale score, and Rad-score were independently associated with outcome. The clinical-radiomics nomogram showed good predictive performance with AUCs of 0.882 (95% CI: 0.859-0.905), 0.834 (95% CI: 0.776-0.891) and 0.905 (95% CI: 0.839-0.970) in the three cohorts and clinical applicability. CONCLUSION NCCT-based radiomics features from PHE are highly correlated with outcome. When combined with Rad-score, radiomics features from PHE can improve the predictive performance for 90-day poor outcome in patients with ICH.
Collapse
Affiliation(s)
- Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Yaqiong Ma
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730030, China
| | - Qiaoying Zhang
- Department of Radiology, Xi'an Central Hospital, Xi An, 710000, China
| | | | - Hui Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Zhiyong Zhao
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Min Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China.
| |
Collapse
|
9
|
Choi JH, Yoon WK, Kim JH, Kwon TH, Byun J. Predictor of the Postoperative Swelling After Craniotomy for Spontaneous Intracerebral Hemorrhage: Sphericity Index as a Novel Parameter. Korean J Neurotrauma 2023; 19:333-347. [PMID: 37840614 PMCID: PMC10567521 DOI: 10.13004/kjnt.2023.19.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Spontaneous intracerebral hemorrhage is a serious type of stroke with high mortality and disability rates. Surgical treatment options vary; however, predicting edema aggravation is crucial when choosing the optimal approach. We propose using the sphericity index, a measure of roundness, to predict the aggravation of edema and guide surgical decisions. Methods We analyzed 56 cases of craniotomy and hematoma evacuation to investigate the correlation between the sphericity index and patient outcomes, including the need for salvage decompressive craniectomy (DC). Results The patients included 35 (62.5%) men and 21 (37.5%) women, with a median age of 62.5 years. The basal ganglia was the most common location of hemorrhage (50.0%). The mean hematoma volume was 86.3 cc, with 10 (17.9%) instances of hematoma expansion. Cerebral herniation was observed in 44 (78.6%) patients, intraventricular hemorrhage in 34 (60.7%), and spot signs in 9 (16.1%). Salvage DC was performed in 13 (23.6%) patients to relieve intracranial pressure. The median follow-up duration was 6 months, with a mortality rate of 12.5%. The sphericity index was significantly correlated with delayed swelling and hematoma expansion but not salvage DC. Conclusions The sphericity index is a promising predictor of delayed swelling and hematoma expansion that may aid in the development of surgical guidelines and medication strategies. Further large-scale studies are required to explore these aspects and establish comprehensive guidelines.
Collapse
Affiliation(s)
- Jae Hoon Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Ki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Marchina S, Lee KH, Lioutas VA, Carvalho F, Incontri D, Heistand EC, Lin D, Selim M. An updated systematic review and meta-analysis investigating perihematomal edema and clinical outcome after intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107204. [PMID: 37302208 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES The relationship between perihematomal edema (PHE) and intracerebral hemorrhage (ICH) outcomes is uncertain. Given newly published studies, we updated a previous systematic review and meta-analysis assessing the prognostic impact of PHE on ICH outcomes. MATERIALS AND METHODS Databases were searched through September 2022 using pre-defined keywords. Included studies used regression to examine the association between PHE and functional outcome (assessed by modified Rankin Scale [mRS]) and mortality. The study quality was assessed using the Newcastle-Ottawa Scale. The overall pooled effect, and secondary analyses exploring different subgroups were obtained by entering the log transformed odds ratios and their confidence intervals into a DerSimonian-Laird random effects meta-analysis. RESULTS Twenty-eight studies (n=8655) were included. The pooled effect size for overall outcome (mRS and mortality) was 1.05 (95% CI 1.03, 1.07; p<0.00). In secondary analyses, PHE volume and growth effect sizes were 1.03 (CI 1.01, 1.05) and 1.12 (CI 1.06, 1.19), respectively. Results of subgroup analyses assessing absolute PHE volume and growth at different time points were: baseline volume 1.02 (CI 0.98, 1.06), 72-hour volume 1.07 (CI 0.99, 1.16), growth at 24 hours 1.30 (CI 0.96, 1.74) and growth at 72 hours 1.10 (CI 1.04, 1.17). Heterogeneity across studies was substantial. CONCLUSIONS This meta-analysis indicates that PHE growth, especially within the first 24 hours after ictus, has a stronger impact on functional outcome and mortality than PHE volume. Definitive conclusions are limited by the large variability of PHE measures, heterogeneity, and different evaluation time points between studies.
Collapse
Affiliation(s)
- Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Kun He Lee
- Department of Neurology, Stroke Division, Yale New Haven Hospital, New Haven, CT, United States
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Filipa Carvalho
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Diego Incontri
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Elizabeth C Heistand
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - David Lin
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| |
Collapse
|
11
|
Zhang Y, Liu Y, Zhang X, Yong VW, Xue M. Omarigliptin Protects the Integrity of the Blood-Brain Barrier After Intracerebral Hemorrhage in Mice. J Inflamm Res 2023; 16:2535-2548. [PMID: 37342770 PMCID: PMC10278948 DOI: 10.2147/jir.s411017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose Intracerebral hemorrhage (ICH) is a fatal disease without effective treatment. The damage of the blood-brain barrier (BBB) is a key cause of brain edema and herniation after ICH. Omarigliptin (also known as MK3102) is a potent antidiabetic that inhibits dipeptidyl peptidase (DPP4); the latter has the ability to bind and degrade matrix metalloproteinases (MMPs). The present study aims to investigate the protective effects of omarigliptin against the destruction of BBB following ICH in mice. Methods and Materials Collagenase VII was used to induce ICH in C57BL/6 mice. MK3102 (7 mg/kg/day) was administered after ICH. The modified neurological severity scores (mNSS) were carried out to assess neurological functions. Nissl staining was applied to evaluate neuronal loss. Brain water content, Evans blue extravasation, Western blots, immunohistochemistry and immunofluorescence were used to study the protective effects of BBB with MK3102 at 3 days after ICH. Results MK3102 reduced DPP4 expression and decreased hematoma formation and neurobehavioral deficits of ICH mice. This was correspondent with lowered activation of microglia/macrophages and infiltration of neutrophils after ICH. Importantly, MK3102 protected the integrity of the BBB after ICH, associated with decreased expression of MMP-9, and preservation of the tight junction proteins ZO-1 and Occludin on endothelial cells through putative degradation of MMP-9, and inhibition of the expression of CX43 on astrocytes. Conclusion Omarigliptin protects the integrity of the BBB in mice after ICH injury.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Yang Liu
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Xiangyu Zhang
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - V Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| |
Collapse
|
12
|
Cliteur MP, Sondag L, Cunningham L, Al-Shahi Salman R, Samarasekera N, Klijn CJM, Schreuder FHBM. The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis. Eur Stroke J 2023; 8:423-433. [PMID: 37231691 PMCID: PMC10334181 DOI: 10.1177/23969873231157884] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/27/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Perihaematomal oedema (PHO) formation has gained increasing interest as a therapeutic target after spontaneous intracerebral haemorrhage (ICH). Whether PHO contributes to poor outcome is unclear. We aimed to determine the association between PHO and outcome in patients with spontaneous ICH. METHOD We searched five databases up to 17 November 2021 for studies of ⩾10 adults with ICH reporting the presence of PHO and outcome. We assessed risk of bias, extracted aggregate data and used random effects meta-analysis to pool studies that reported odds ratios (OR) with 95% confidence intervals (CI). Primary outcome was poor functional outcome defined as modified Rankin Scale score of 3-6 at 3 months. Additionally, we assessed PHO growth and poor outcome at any time of follow-up. We prospectively registered the protocol in PROSPERO (CRD42020157088). FINDINGS We identified 12,968 articles, of which we included 27 studies (n = 9534). Eighteen studies reported an association between larger PHO volume and poor outcome, six a neutral result and three an inverse relationship. Larger absolute PHO volume was associated with poor functional outcome at 3 months (OR per mL increase of absolute PHO 1.03, 95% CI 1.00-1.06, I2 44%, four studies). Additionally, PHO growth was associated with poor outcome (OR 1.04, 95% CI 1.02-1.06, I2 0%, seven studies). DISCUSSION In patients with spontaneous ICH, larger PHO volume is associated with poor functional outcome at 3 months. These findings support the development and investigation of new therapeutic interventions targeting PHO formation to evaluate if reduction of PHO improves outcome after ICH.
Collapse
Affiliation(s)
- Maaike P Cliteur
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Cunningham
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | | | - Catharina JM Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Floris HBM Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Esparza WD, Aladro-Gonzalvo AR, Ruíz-Hontangas A, Celi D, Aguirre MB. The Effect of Craniofacial Manual Lymphatic Drainage after Moderate Traumatic Brain Injury. Healthcare (Basel) 2023; 11:healthcare11101474. [PMID: 37239760 DOI: 10.3390/healthcare11101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/24/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Previous studies suggest that craniofacial manual lymphatic drainage (MLD) facilitates brain fluids clearance, reducing intracranial pressure and reabsorbing chronic subdural hematoma. This study aimed to explore the effect of craniofacial MLD in combination with pharmacological treatment for improving cranial pain intensity, vital signs, and cerebral edema (Hounsfield units, HUs) in moderate traumatic brain injury (mTBI). Patient 1 received pharmacological therapy, while patient 2 received both pharmacological and craniocervical MLD treatment. Patient 2 showed decreased cranial pain intensity and systolic blood pressure (66%-11.11%, respectively) after two 30 min daily sessions of treatment for three days. HUs in the caudate nucleus of both hemispheres (left 24.64%-right 28.72%) and in the left temporal cortical gray matter increased (17.8%). An increase in HU suggests a reduction in cerebral edema and vice versa. For patient 1, there were no changes in cranial pain intensity, but a slight increase in the systolic blood pressure was observed (0%-3.27%, respectively). HUs decreased in the temporal cortical (14.98%) and caudate nucleus gray matter (9.77%) of the left and right cerebral hemispheres (11.96%-16.74%, respectively). This case study suggests that craniofacial MLD combined with pharmacological treatment could reduce cerebral edema, decrease head pain intensity, and maintain vital signs in normal physiologic values in patients with mTBI.
Collapse
Affiliation(s)
- Wilmer Danilo Esparza
- Facultad de Enfermería, Pontificia Universidad Católica del Ecuador, Quito 170143, Ecuador
- School of Physical Therapy, Universidad de Las Américas, Quito 170513, Ecuador
| | | | | | - Daniela Celi
- School of Physical Therapy, Universidad de Las Américas, Quito 170513, Ecuador
| | - María Belén Aguirre
- School of Physical Therapy, Universidad de Las Américas, Quito 170513, Ecuador
| |
Collapse
|
14
|
Wan Y, Holste KG, Hua Y, Keep RF, Xi G. Brain edema formation and therapy after intracerebral hemorrhage. Neurobiol Dis 2023; 176:105948. [PMID: 36481437 PMCID: PMC10013956 DOI: 10.1016/j.nbd.2022.105948] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for about 10% of all strokes in the United States of America causing a high degree of disability and mortality. There is initial (primary) brain injury due to the mechanical disruption caused by the hematoma. There is then secondary injury, triggered by the initial injury but also the release of various clot-derived factors (e.g., thrombin and hemoglobin). ICH alters brain fluid homeostasis. Apart from the initial hematoma mass, ICH causes blood-brain barrier disruption and parenchymal cell swelling, which result in brain edema and intracranial hypertension affecting patient prognosis. Reducing brain edema is a critical part of post-ICH care. However, there are limited effective treatment methods for reducing perihematomal cerebral edema and intracranial pressure in ICH. This review discusses the mechanisms underlying perihematomal brain edema formation, the effects of sex and age, as well as how edema is resolved. It examines progress in pharmacotherapy, particularly focusing on drugs which have been or are currently being investigated in clinical trials.
Collapse
Affiliation(s)
- Yingfeng Wan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
15
|
Zhou P, Sun Q, Song G, Liu Z, Qi J, Yuan X, Wang X, Yan S, Du J, Dai Z, Wang J, Hu S. Radiomics features from perihematomal edema for prediction of prognosis in the patients with basal ganglia hemorrhage. Front Neurol 2022; 13:982928. [DOI: 10.3389/fneur.2022.982928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
ObjectiveWe developed and validated a clinical-radiomics nomogram to predict the prognosis of basal ganglia hemorrhage patients.MethodsRetrospective analyses were conducted in 197 patients with basal ganglia hemorrhage (training cohort: n = 136, test cohort: n = 61) who were admitted to The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) and underwent computed tomography (CT) scan. According to different prognoses, patients with basal ganglia hemorrhage were divided into two groups. Independent clinical risk factors were derived with univariate and multivariate regression analysis. Radiomics signatures were obtained using least absolute shrinkage and selection operator. A radiomics score (Rad-score) was generated by 12 radiomics signatures of perihematomal edema (PHE) from CT images that were correlated with the prognosis of basal ganglia hemorrhage patients. A clinical-radiomics nomogram was conducted by combing the Rad-score and clinical risk factors using logistic regression analysis. The prediction performance of the nomogram was tested in the training cohort and verified in the test cohort.ResultsThe clinical model conducted by four clinical risk factors and 12 radiomcis features were used to establish the Rad-score. The clinical-radiomics nomogram outperformed the clinical model in the training cohort [area under the curve (AUC), 0.92 vs. 0.85] and the test cohort (AUC, 0.91 vs 0.85). The clinical-radiomics nomogram showed good calibration and clinical benefit in both the training and test cohorts.ConclusionRadiomics features of PHE in patients with basal ganglia hemorrhage could contribute to the outcome prediction. The clinical-radiomics nomogram may help first-line clinicians to make individual clinical treatment decisions for patients with basal ganglia hemorrhage.
Collapse
|
16
|
Zhang X, Zhu HC, Yang D, Zhang FC, Mane R, Sun SJ, Zhao XQ, Zhou J. Association between cerebral blood flow changes and blood-brain barrier compromise in spontaneous intracerebral haemorrhage. Clin Radiol 2022; 77:833-839. [PMID: 35786315 DOI: 10.1016/j.crad.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
AIM To quantitatively evaluate blood-brain barrier (BBB) permeability in the perihaematomal region of spontaneous intracerebral haemorrhage (ICH) and investigate the association between the alterations in cerebral blood flow and BBB permeability around the haematoma. MATERIALS AND METHODS Spontaneous ICH patients underwent unenhanced computed tomography (CT) and CT perfusion (CTP) simultaneously. Haematoma volume was measured on CT. The values of cerebral haemodynamic parameters including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and permeability-surface area product (PS) were measured in the perihaematomal region and the contralateral mirror region, and then relative values were calculated for statistical analysis. Linear regression was used to evaluate associations between BBB permeability and variables. RESULTS A total of 87 ICH patients were included in this study. The focally elevated BBB permeability was observed in the perihaematomal region in ICH patients. Linear regression showed that reduced rCBF (β = -0.379, p=0.001) and increased rCBV (β = 0.412, p=0.000) correlated independently with increased relative PS (rPS) value in deep ICH, while only increased rCBV (β = 0.423, p=0.071) correlated to increased rPS value in patients with lobar ICH. CONCLUSIONS BBB permeability is focally elevated in the region around the haematoma. Cerebral haemodynamic alterations are associated with increased BBB permeability. Cerebral hypoperfusion may aggravate BBB compromise, and a compensatory increase in CBV may lead to reperfusion injury on BBB.
Collapse
Affiliation(s)
- X Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - H C Zhu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - D Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - F C Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - R Mane
- China National Clinical Research Center-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, Beijing, China
| | - S J Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Affiliated Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - X Q Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - J Zhou
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
17
|
Affiliation(s)
- Kevin N Sheth
- From the Division of Neurocritical Care and Emergency Neurology, Departments of Neurology and Neurosurgery, and the Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT
| |
Collapse
|
18
|
Molecular, Pathological, Clinical, and Therapeutic Aspects of Perihematomal Edema in Different Stages of Intracerebral Hemorrhage. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3948921. [PMID: 36164392 PMCID: PMC9509250 DOI: 10.1155/2022/3948921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
Acute intracerebral hemorrhage (ICH) is a devastating type of stroke worldwide. Neuronal destruction involved in the brain damage process caused by ICH includes a primary injury formed by the mass effect of the hematoma and a secondary injury induced by the degradation products of a blood clot. Additionally, factors in the coagulation cascade and complement activation process also contribute to secondary brain injury by promoting the disruption of the blood-brain barrier and neuronal cell degeneration by enhancing the inflammatory response, oxidative stress, etc. Although treatment options for direct damage are limited, various strategies have been proposed to treat secondary injury post-ICH. Perihematomal edema (PHE) is a potential surrogate marker for secondary injury and may contribute to poor outcomes after ICH. Therefore, it is essential to investigate the underlying pathological mechanism, evolution, and potential therapeutic strategies to treat PHE. Here, we review the pathophysiology and imaging characteristics of PHE at different stages after acute ICH. As illustrated in preclinical and clinical studies, we discussed the merits and limitations of varying PHE quantification protocols, including absolute PHE volume, relative PHE volume, and extension distance calculated with images and other techniques. Importantly, this review summarizes the factors that affect PHE by focusing on traditional variables, the cerebral venous drainage system, and the brain lymphatic drainage system. Finally, to facilitate translational research, we analyze why the relationship between PHE and the functional outcome of ICH is currently controversial. We also emphasize promising therapeutic approaches that modulate multiple targets to alleviate PHE and promote neurologic recovery after acute ICH.
Collapse
|
19
|
Chen Z, Ding J, Wu X, Cao X, Liu H, Yin X, Ding Y, Ji X, Meng R. Anatomic Asymmetry of Transverse Sinus May Be Irrelevant to the Prognosis of Intracerebral Hemorrhage. Neurologist 2022; 27:235-239. [PMID: 34873112 PMCID: PMC9439688 DOI: 10.1097/nrl.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigate the probable effect of anatomic asymmetry of transverse sinus (TS) on the outcomes of acute intracerebral hemorrhage (ICH), to provide reference for customized treatment. METHODS Consecutive patients with imaging-confirmed acute ICH were enrolled from October 2015 through October 2019, and divided into 2 groups: symmetrical and unilateral (left or right) slender TS groups, based on the status of TS in imaging maps. Brain computed tomography (CT) maps of all patients at baseline and half-month post-ICH were obtained, and the volumes of hematoma and the perihematomal edemas (PHE), as well as the modified Rankin Scale (mRS) scores at the month-3 post-ICH between the 2 groups were assessed and analyzed. RESULTS A total of 46 eligible patients entered into final analysis, including 18 cases in the slender TS group (14 cases involved the left side while 4 cases involved the right side), and 28 cases in the symmetrical TS group. The mRS scores, hematoma absorption rates, and the residual volumes of PHE of all patients in the 2 groups at half-month post-ICH showed no statistical significance (all P >0.05), and all of the items mentioned above were related to the hematoma volume at baseline (all P <0.001). At the month-3 follow-up post-ICH, the mRS scores between the 2 groups showed no statistical significance as well ( P =0.551). CONCLUSIONS Anatomic asymmetry of TS may not affect the prognosis of PHE and clinical outcome after ICH.
Collapse
Affiliation(s)
- Zhiying Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Jiayue Ding
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqin Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Xianming Cao
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Hao Liu
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Xiaoping Yin
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiangxi
| | - Yuchuan Ding
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
| | - Xunming Ji
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing
| |
Collapse
|
20
|
Ironside N, Patrie J, Ng S, Ding D, Rizvi T, Kumar JS, Mastorakos P, Hussein MZ, Naamani KE, Abbas R, Harrison Snyder M, Zhuang Y, Kearns KN, Doan KT, Shabo LM, Marfatiah S, Roh D, Lignelli-Dipple A, Claassen J, Worrall BB, Johnston KC, Jabbour P, Park MS, Sander Connolly E, Mukherjee S, Southerland AM, Chen CJ. Quantification of hematoma and perihematomal edema volumes in intracerebral hemorrhage study: Design considerations in an artificial intelligence validation (QUANTUM) study. Clin Trials 2022; 19:534-544. [PMID: 35786006 DOI: 10.1177/17407745221105886] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hematoma and perihematomal edema volumes are important radiographic markers in spontaneous intracerebral hemorrhage. Accurate, reliable, and efficient quantification of these volumes will be paramount to their utility as measures of treatment effect in future clinical studies. Both manual and semi-automated quantification methods of hematoma and perihematomal edema volumetry are time-consuming and susceptible to inter-rater variability. Efforts are now underway to develop a fully automated algorithm that can replace them. A (QUANTUM) study to establish inter-quantification method measurement equivalency, which deviates from the traditional use of measures of agreement and a comparison hypothesis testing paradigm to indirectly infer quantification method measurement equivalence, is described in this article. The Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study aims to determine whether a fully automated quantification method and a semi-automated quantification method for quantification of hematoma and perihematomal edema volumes are equivalent to the hematoma and perihematomal edema volumes of the manual quantification method. METHODS/DESIGN Hematoma and perihematomal edema volumes of supratentorial intracerebral hemorrhage on 252 computed tomography scans will be prospectively quantified in random order by six raters using the fully automated, semi-automated, and manual quantification methods. Primary outcome measures for hematoma and perihematomal edema volumes will be quantified via computed tomography scan on admission (<24 h from symptom onset) and on day 3 (72 ± 12 h from symptom onset), respectively. Equivalence hypothesis testing will be conducted to determine if the hematoma and perihematomal edema volume measurements of the fully automated and semi-automated quantification methods are within 7.5% of the hematoma and perihematomal edema volume measurements of the manual quantification reference method. DISCUSSION By allowing direct equivalence hypothesis testing, the Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study offers advantages over radiology validation studies which utilize measures of agreement to indirectly infer measurement equivalence and studies which mistakenly try to infer measurement equivalence based on the failure of a comparison two-sided null hypothesis test to reach the significance level for rejection. The equivalence hypothesis testing paradigm applied to artificial intelligence application validation is relatively uncharted and warrants further investigation. The challenges encountered in the design of this study may influence future studies seeking to translate artificial intelligence medical technology into clinical practice.
Collapse
Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sherman Ng
- Department of Software Engineering, Microsoft Corporation, Redmond, WA, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mohamed Z Hussein
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Yan Zhuang
- Department of Biomedical Engineering and Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kevin T Doan
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leah M Shabo
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Saurabh Marfatiah
- Department of Radiology, Columbia University School of Medicine, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | | | - Jan Claassen
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | - Bradford B Worrall
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen C Johnston
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - E Sander Connolly
- Department of Neurosurgery, Columbia University School of Medicine, New York, NY, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andrew M Southerland
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA
| |
Collapse
|
21
|
Rendevski V, Aleksovski B, Mihajlovska Rendevska A, Hadzi-Petrushev N, Manusheva N, Shuntov B, Gjorgoski I. Inflammatory and oxidative stress markers in intracerebral hemorrhage: Relevance as prognostic markers for quantification of the edema volume. Brain Pathol 2022; 33:e13106. [PMID: 35762501 PMCID: PMC10041164 DOI: 10.1111/bpa.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 01/24/2023] Open
Abstract
We aimed to analyze the inflammatory and oxidative stress (OS) markers after intracerebral hemorrhage (ICH) and their temporal changes, interaction effects, and prognostic values as biomarkers for the prediction of the edema volume. Our prospective, longitudinal study included a cohort group of 73 conservatively treated patients with ICH, without hematoma expansion or intraventricular bleeding, which were initialized with the same treatment and provided with the same in-hospital care during the disease course. Study procedures included multilevel comprehensive analyses of clinical and neuroimaging data, aligned with the exploration of 19 inflammatory and five OS markers. White blood cells (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophilia, and lymphopenia peaked 3 days post-ICH, and they showed much stronger correlations with clinical and neuroimaging variables, when compared to the admission values. An intricate interplay among inflammatory (WBC, CRP, neutrophils, neutrophil-to-lymphocyte ratio [NLR], interleukin (IL)-6, and IL-10) and OS mechanisms (catalase activity and advanced oxidation protein products [AOPP]) was detected operating 3-days post-ICH, being assessed as relevant for prediction of the edema. The overall results suggested complex pathology of formation of post-ICH edema, via: (A) Not additive, but statistically significant synergistic interactions between CRP-ESR, neutrophils-CRP, and neutrophils-IL-6 as drivers for the edema formation; (B) Significant antagonistic effect of high protein oxidation on the CRP-edema dependence, suggesting a mechanism of potential OS-CRP negative feedback loop and redox inactivation of CRP. The final multiple regression model separated the third-day variables NLR, CRP × AOPP, and WBC, as significant prognostic biomarkers for the prediction of the edema volume, with NLR being associated with the highest effect size. Our developed mathematical equation with 3D modeling for prediction and quantification of the edema volume might be beneficial for taking timely adequate strategies for prevention of delayed neurological deteriorations.
Collapse
Affiliation(s)
- Vladimir Rendevski
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Boris Aleksovski
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | | | - Nikola Hadzi-Petrushev
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Nensi Manusheva
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Blagoj Shuntov
- Medical Faculty, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Icko Gjorgoski
- Faculty of Natural Sciences and Mathematics-Skopje, Institute of Biology, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| |
Collapse
|
22
|
Lee KH, Lioutas VA, Marchina S, Selim M. The Prognostic Roles of Perihematomal Edema and Ventricular Size in Patients with Intracerebral Hemorrhage. Neurocrit Care 2022; 37:455-462. [PMID: 35676589 DOI: 10.1007/s12028-022-01532-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conflicting data exist regarding the association of perihematomal edema (PHE) with outcomes after intracerebral hemorrhage (ICH). We performed a post hoc analysis of the ICH Deferoxamine trial to examine whether an early change in ventricular size (VS), as a composite measure of PHE growth and mass effect, intraventricular hemorrhage, and hydrocephalus, is a more accurate predictor of outcome than PHE measures alone. METHODS Computerized tomography scans were performed at baseline and after 72-96 h. We evaluated measures of PHE and change in VS as predictors of outcome, assessed by a dichotomized modified Rankin Scale score (0-2 versus 3-6), primarily at 90 days and secondarily at 30 days. A multivariable logistic regression model was fitted for each predictor, with adjustment for the same confounders. RESULTS A total of 248 participants were included after we excluded those requiring external ventricular drains. On univariate analyses, older age, female sex, lower Glasgow Coma Scale score and baseline temperature, greater ICH volume, absolute PHE volume, edema extension distance at presentation, lesser changes in relative PHE volume and edema extension distance, and an increase in VS were associated with poor outcome. In multivariable analyses, only the increase in VS was associated with lower odds of modified Rankin Scale scores 0-2 at 90 days (odds ratio 0.927, 95% confidence interval 0.866-0.970, p = 0.001) and 30 days (odds ratio 0.931, 95% confidence interval 0.888-0.975, p = 0.003). CONCLUSIONS Within the context of a randomized controlled trial with standardized imaging and functional assessments, we did not find significant associations between measures of PHE and outcome but documented an independent association between early increase in VS and lower odds of good clinical outcome.
Collapse
Affiliation(s)
- Kun He Lee
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA.
| | - Vasileios-Arsenios Lioutas
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Sarah Marchina
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Magdy Selim
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | | |
Collapse
|
23
|
Chen Y, Qin C, Chang J, Liu Y, Zhang Q, Ye Z, Li Z, Tian F, Ma W, Wei J, Feng M, Chen S, Yao J, Wang R. Defining Delayed Perihematomal Edema Expansion in Intracerebral Hemorrhage: Segmentation, Time Course, Risk Factors and Clinical Outcome. Front Immunol 2022; 13:911207. [PMID: 35615357 PMCID: PMC9125313 DOI: 10.3389/fimmu.2022.911207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
We attempt to generate a definition of delayed perihematomal edema expansion (DPE) and analyze its time course, risk factors, and clinical outcomes. A multi-cohort data was derived from the Chinese Intracranial Hemorrhage Image Database (CICHID). A non-contrast computed tomography (NCCT) -based deep learning model was constructed for fully automated segmentation hematoma and perihematomal edema (PHE). Time course of hematoma and PHE evolution correlated to initial hematoma volume was volumetrically assessed. Predictive values for DPE were calculated through receiver operating characteristic curve analysis and were tested in an independent cohort. Logistic regression analysis was utilized to identify risk factors for DPE formation and poor outcomes. The test cohort’s Dice scores of lesion segmentation were 0.877 and 0.642 for hematoma and PHE, respectively. Overall, 1201 patients were enrolled for time-course analysis of ICH evolution. A total of 312 patients were further selected for DPE analysis. Time course analysis showed the growth peak of PHE approximately concentrates in 14 days after onset. The best cutoff for DPE to predict poor outcome was 3.34 mL of absolute PHE expansion from 4-7 days to 8-14 days (AUC=0.784, sensitivity=72.2%, specificity=81.2%), and 3.78 mL of absolute PHE expansion from 8-14 days to 15-21 days (AUC=0.682, sensitivity=59.3%, specificity=92.1%) in the derivation sample. Patients with DPE was associated with worse outcome (OR: 12.340, 95%CI: 6.378-23.873, P<0.01), and the larger initial hematoma volume (OR: 1.021, 95%CI: 1.000-1.043, P=0.049) was the significant risk factor for DPE formation. This study constructed a well-performance deep learning model for automatic segmentations of hematoma and PHE. A new definition of DPE was generated and is confirmed to be related to poor outcomes in ICH. Patients with larger initial hematoma volume have a higher risk of developing DPE formation.
Collapse
Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Qinghua Zhang
- Department of Neurosurgery, Shenzhen Nanshan Hospital, Shenzhen, China
| | - Zeju Ye
- Department of Neurosurgery, Dongguan People's Hospital, Dongguan, China
| | - Zhaojian Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Medicine, Qingdao University, Qingdao, China
| | - Fengxuan Tian
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
24
|
Marchina S, Trevino-Calderon JA, Hassani S, Massaro JM, Lioutas VA, Carvalho F, Selim M. Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Neurocrit Care 2022; 37:351-362. [PMID: 35578090 DOI: 10.1007/s12028-022-01512-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/05/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) has been proposed as a radiological marker of secondary injury and therapeutic target in intracerebral hemorrhage (ICH). We conducted a systematic review and meta-analysis to assess the prognostic impact of PHE on functional outcome and mortality in patients with ICH. METHODS We searched major databases through December 2020 using predefined keywords. Any study using logistic regression to examine the association between PHE or its growth and functional outcome was included. We examined the overall pooled effect and conducted secondary analyses to explore the impact of individual PHE measures on various outcomes separately. Study quality was assessed by three independent raters using the Newcastle-Ottawa Scale. Odds ratios (per 1-unit increase in PHE) and their confidence intervals (CIs) were log transformed and entered into a DerSimonian-Laird random-effects meta-analysis to obtain pooled estimates of the effect. RESULTS Twenty studies (n = 6633 patients) were included in the analysis. The pooled effect size for overall outcome was 1.05 (95% CI 1.02-1.08; p < 0.00). For the following secondary analyses, the effect size was weak: mortality (1.01; 95% CI 0.90-1.14), functional outcome (1.04; 95% CI 1.02-1.07), both 90-day (1.06; 95% CI 1.02-1.11), and in-hospital assessments (1.04; 95% CI 1.00-1.08). The effect sizes for PHE volume and PHE growth were 1.04 (95% CI 1.01-1.07) and 1.14 (95% CI 1.04-1.25), respectively. Heterogeneity across studies was substantial except for PHE growth. CONCLUSIONS This meta-analysis demonstrates that PHE volume within the first 72 h after ictus has a weak effect on functional outcome and mortality after ICH, whereas PHE growth might have a slightly larger impact during this time frame. Definitive conclusions are limited by the large variability of PHE measures, heterogeneity, and different evaluation time points between studies.
Collapse
Affiliation(s)
- Sarah Marchina
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Jorge A Trevino-Calderon
- Division of Child Neurology, Children's Medical Center, University of Texas Southwestern, Dallas, TX, USA
| | - Sara Hassani
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Vasileios-Arsenios Lioutas
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Filipa Carvalho
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Magdy Selim
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| |
Collapse
|
25
|
Mureșan EM, Golea A, Vesa Ș, Lenghel M, Csutak C, Perju‑Dumbravă L. Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study. Exp Ther Med 2022; 23:200. [PMID: 35126703 PMCID: PMC8794556 DOI: 10.3892/etm.2022.11123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/06/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (sICH) results in high morbidity and mortality rates, thus identifying strategies for timely prognosis and treatment is important. The present study aimed to analyze the relationship between emergency department point-of-care (POC) blood biomarkers and day 90 functional outcome (FO) in patients with acute (<8 h) sICH. On-site POC determinations, including complete blood count, glucose, cardiac troponin I, D-dimer and C-reactive protein, and derived inflammatory indexes were performed for a cohort of 35 patients. The primary endpoint was a favorable day 90 FO (modified Rankin Score ≤3). Secondary endpoints included early neurological worsening (ENW), day 7/discharge neurological impairment, day 90 independence assessment (Barthel Index <60), hematoma enlargement and perihematomal edema (PHE) growth. A favorable three-month FO was reported in 16 (46%) participants. Older age, previous history of ischemic stroke and initial imagistic parameters, including intraventricular hemorrhage, enlarged contralateral ventricle and cerebral atrophy, significantly predicted an unfavorable FO. The admission D-dimer similarly predicted day 90 FO and the independence status, along with ENW and a more severe day 7/discharge neurological status. The D-dimer also correlated with the initial neurological status and PHE. PHE growth correlated with granulocytes, systemic immune-inflammation index and glycemia. The results suggested that a lower admission D-dimer could indicate an improved day 90 FO of patients with sICH, while also anticipating the development of PHE growth and ENW.
Collapse
Affiliation(s)
- Eugenia-Maria Mureșan
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Adela Golea
- Department of Surgery, Emergency Medicine Discipline, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400006 Cluj‑Napoca, Romania
| | - Ștefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400349 Cluj‑Napoca, Romania
| | - Manuela Lenghel
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Csaba Csutak
- Department of Surgical Specialties, Radiology Discipline, ‘Iuliu Hațieganu’, University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania
| | - Lăcrămioara Perju‑Dumbravă
- Department of Neurosciences, Faculty of Medicine, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| |
Collapse
|
26
|
Chen Y, Chen S, Chang J, Wei J, Feng M, Wang R. Perihematomal Edema After Intracerebral Hemorrhage: An Update on Pathogenesis, Risk Factors, and Therapeutic Advances. Front Immunol 2021; 12:740632. [PMID: 34737745 PMCID: PMC8560684 DOI: 10.3389/fimmu.2021.740632] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has one of the worst prognoses among patients with stroke. Surgical measures have been adopted to relieve the mass effect of the hematoma, and developing targeted therapy against secondary brain injury (SBI) after ICH is equally essential. Numerous preclinical and clinical studies have demonstrated that perihematomal edema (PHE) is a quantifiable marker of SBI after ICH and is associated with a poor prognosis. Thus, PHE has been considered a promising therapeutic target for ICH. However, the findings derived from existing studies on PHE are disparate and unclear. Therefore, it is necessary to classify, compare, and summarize the existing studies on PHE. In this review, we describe the growth characteristics and relevant underlying mechanism of PHE, analyze the contributions of different risk factors to PHE, present the potential impact of PHE on patient outcomes, and discuss the currently available therapeutic strategies.
Collapse
Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW Nontraumatic intracerebral hemorrhage (ICH) is the second most common type of stroke. This article summarizes the basic pathophysiology, classification, and management of ICH and discusses the available evidence on therapy for hematoma, hematoma expansion, and perihematomal edema. RECENT FINDINGS Current available data on potential therapeutic options for ICH are promising, although none of the trials have shown improvement in mortality rate. The literature available on reversal of anticoagulation and antiplatelet agents after an ICH and resumption of these medications is also increasing. SUMMARY ICH continues to have high morbidity and mortality. Advances in therapeutic options to target secondary brain injury from the hematoma, hematoma expansion, and perihematomal edema are increasing. Data on reversal therapy for anticoagulant-associated or antiplatelet-associated ICH and resumption of these medications are evolving.
Collapse
|
28
|
Early Perihematomal Edema Expansion: Definition, Significance, and Association with Outcomes after Intracerebral Hemorrhage. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6249509. [PMID: 34552686 PMCID: PMC8452407 DOI: 10.1155/2021/6249509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate the association between early perihematomal edema (PHE) expansion and functional outcome in patients with intracerebral hemorrhage (ICH). Methods Patients with ICH who underwent initial computed tomography (CT) scans within 6 hours after the onset of symptoms and follow-up CT scans within 24 ± 12 hours were included. Absolute PHE increase was defined as the absolute increase in PHE volume from baseline to 24 hours. A receiver-operating characteristic (ROC) curve was generated to determine the cutoff value for early PHE expansion, which was operationally defined as an absolute increase in PHE volume of >6 mL. The outcome of interest was 3-month poor outcome defined as modified Rankin scale score of ≥4. A multivariable logistic regression procedure was used to assess the association between early PHE expansion and outcome after ICH. Results In 233 patients with ICH, 89 (38.2%) patients had poor outcome at 3-month follow-up. Early PHE expansion was observed in 56 of 233 (24.0%) patients. Patients with early PHE expansion were more likely to have poor functional outcome than those without (43.8% vs. 11.8%, p < 0.001). After adjusting for age, admission systolic blood pressure, admission Glasgow Coma Scale score, baseline ICH volume and the presence of intraventricular hemorrhage, and time from onset to CT, early PHE expansion was associated with poor outcome (adjusted odds ratio, 4.25; 95% confidence interval, 1.70–10.60; p = 0.002). Conclusions The early PHE expansion was not uncommon in patients with ICH and was correlated with poor outcome following ICH.
Collapse
|
29
|
Wang J, Chen Y, Liang J, Cao M, Shen J, Ke K. Study of the pathology and the underlying molecular mechanism of tissue injury around hematoma following intracerebral hemorrhage. Mol Med Rep 2021; 24:702. [PMID: 34368865 PMCID: PMC8365418 DOI: 10.3892/mmr.2021.12341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
Intracerebral hemorrhage (ICH) refers to hemorrhage caused by spontaneous rupture of blood vessels in the brain. Brain injury due to ICH leads to catastrophic effects resulting from the formation of hematoma and oxidative stress caused by components of lysed erythrocytes. However, not all neurons in the area surrounding the hematoma die immediately: A number of neurons remain in a critical, but reversible, state; however, the genes involved in this critical state remain poorly understood. Gene chip technology was used identify changes in the area surrounding the hematoma associated with the upregulation of 210 and downregulation of 173 genes. Gene Ontology functional annotation revealed changes in the gene expression profile in the peripheral region of hematoma following ICH, which were primarily associated with the external stimulation received by the organism, the transmission of harmful information to the cell through the transport of cell membrane proteins, and the regulation of a series of biological processes. Protein interaction network analysis revealed that 11 up-[secreted phosphoprotein 1, dual specificity phosphatase 9, catechol-O-methyltransferase, BAR/IMD domain-containing adaptor protein 2-like 1, plakophilin 2, homer scaffold protein 3, ret proto-oncogene (RET), KIT proto-oncogene, receptor tyrosine kinase, hepsin, connector enhancer of kinase suppressor of Ras 2 and kalirin RhoGEF kinase] and four downregulated genes (transcription factor AP-2β, peptidylprolyl isomerase A, SHOC2 leucine rich repeat scaffold protein and synuclein α) may serve a significant role in the area around hematoma following ICH. Reverse transcription-quantitative PCR was used to verify that these genes were differentially expressed in the ICH compared with the control group. Causal network analysis suggested that the Achaete-scute homolog 1-RET signaling axis served a key role in the repair of nerve injury in the peripheral region of hematoma following ICH. Additionally, in vivo experiments revealed that RET expression was upregulated and co-localized with neurons. Taken together, these results suggested that the changes in the gene expression profile in the area around hematoma following ICH were primarily associated with the repair of damage caused to the nervous system.
Collapse
Affiliation(s)
- Jinglei Wang
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Ying Chen
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jingjing Liang
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Maosheng Cao
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Jiabing Shen
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Kaifu Ke
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| |
Collapse
|
30
|
Ye G, Huang S, Chen R, Zheng Y, Huang W, Gao Z, Cai L, Zhao M, Ma K, He Q, Lin F, Lin Y, Wang D, Fang W, Kang D, Wu X. Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study. Front Neurol 2021; 12:700166. [PMID: 34385972 PMCID: PMC8353085 DOI: 10.3389/fneur.2021.700166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions. Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729). Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016-1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26-15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84-31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03-0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P < 0.001, β = 21.62 95% CI 10.10-33.15). Conclusions: An increase of PHE volume >7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.
Collapse
Affiliation(s)
- Gengzhao Ye
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuna Huang
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Renlong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei Huang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhuyu Gao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lueming Cai
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mingpei Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ke Ma
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiu He
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenhua Fang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
31
|
Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Zeevi T, Majidi S, Filippi CG, Iseke S, Gross M, Acosta JN, Malhotra A, Kim JA, Sansing LH, Falcone GJ, Sheth KN, Payabvash S. Admission computed tomography radiomic signatures outperform hematoma volume in predicting baseline clinical severity and functional outcome in the ATACH-2 trial intracerebral hemorrhage population. Eur J Neurol 2021; 28:2989-3000. [PMID: 34189814 DOI: 10.1111/ene.15000] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Radiomics provides a framework for automated extraction of high-dimensional feature sets from medical images. We aimed to determine radiomics signature correlates of admission clinical severity and medium-term outcome from intracerebral hemorrhage (ICH) lesions on baseline head computed tomography (CT). METHODS We used the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial dataset. Patients included in this analysis (n = 895) were randomly allocated to discovery (n = 448) and independent validation (n = 447) cohorts. We extracted 1130 radiomics features from hematoma lesions on baseline noncontrast head CT scans and generated radiomics signatures associated with admission Glasgow Coma Scale (GCS), admission National Institutes of Health Stroke Scale (NIHSS), and 3-month modified Rankin Scale (mRS) scores. Spearman's correlation between radiomics signatures and corresponding target variables was compared with hematoma volume. RESULTS In the discovery cohort, radiomics signatures, compared to ICH volume, had a significantly stronger association with admission GCS (0.47 vs. 0.44, p = 0.008), admission NIHSS (0.69 vs. 0.57, p < 0.001), and 3-month mRS scores (0.44 vs. 0.32, p < 0.001). Similarly, in independent validation, radiomics signatures, compared to ICH volume, had a significantly stronger association with admission GCS (0.43 vs. 0.41, p = 0.02), NIHSS (0.64 vs. 0.56, p < 0.001), and 3-month mRS scores (0.43 vs. 0.33, p < 0.001). In multiple regression analysis adjusted for known predictors of ICH outcome, the radiomics signature was an independent predictor of 3-month mRS in both cohorts. CONCLUSIONS Limited by the enrollment criteria of the ATACH-2 trial, we showed that radiomics features quantifying hematoma texture, density, and shape on baseline CT can provide imaging correlates for clinical presentation and 3-month outcome. These findings couldtrigger a paradigm shift where imaging biomarkers may improve current modelsfor prognostication, risk-stratification, and treatment triage of ICH patients.
Collapse
Affiliation(s)
- Stefan P Haider
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.,Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Abhi Jain
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Hishan Tharmaseelan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Elisa R Berson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Simon Iseke
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Moritz Gross
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Julian N Acosta
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer A Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lauren H Sansing
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
32
|
Nawabi J, Elsayed S, Morotti A, Speth A, Liu M, Kniep H, McDonough R, Broocks G, Faizy T, Can E, Sporns PB, Fiehler J, Hamm B, Penzkofer T, Bohner G, Schlunk F, Hanning U. Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage Related to Different Oral Anticoagulants. J Clin Med 2021; 10:2234. [PMID: 34063991 PMCID: PMC8196746 DOI: 10.3390/jcm10112234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a need to examine the effects of different types of oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) on perihematomal edema (PHE), which is gaining considerable appeal as a biomarker for secondary brain injury and clinical outcome. METHODS In a large multicenter approach, computed tomography-derived imaging markers for PHE (absolute PHE, relative PHE (rPHE), edema expansion distance (EED)) were calculated for patients with OAC-ICH and NON-OAC-ICH. Exploratory analysis for non-vitamin-K-antagonist OAC (NOAC) and vitamin-K-antagonists (VKA) was performed. The predictive performance of logistic regression models, employing predictors of poor functional outcome (modified Rankin scale 4-6), was explored. RESULTS Of 811 retrospectively enrolled patients, 212 (26.14%) had an OAC-ICH. Mean rPHE and mean EED were significantly lower in patients with OAC-ICH compared to NON-OAC-ICH, p-value 0.001 and 0.007; whereas, mean absolute PHE did not differ, p-value 0.091. Mean EED was also significantly lower in NOAC compared to NON-OAC-ICH, p-value 0.05. Absolute PHE was an independent predictor of poor clinical outcome in NON-OAC-ICH (OR 1.02; 95%CI 1.002-1.028; p-value 0.027), but not in OAC-ICH (p-value 0.45). CONCLUSION Quantitative markers of early PHE (rPHE and EED) were lower in patients with OAC-ICH compared to those with NON-OAC-ICH, with significantly lower levels of EED in NOAC compared to NON-OAC-ICH. Increase of early PHE volume did not increase the likelihood of poor outcome in OAC-ICH, but was independently associated with poor outcome in NON-OAC-ICH. The results underline the importance of etiology-specific treatment strategies. Further prospective studies are needed.
Collapse
Affiliation(s)
- Jawed Nawabi
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (E.C.); (B.H.); (T.P.)
- BIH Biomedical Innovation Academy, Berlin Institute of Health (BIH), 10178 Berlin, Germany;
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Sarah Elsayed
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Anna Speth
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Berlin Institute of Health, Freie Universität Berlin, 10117 Berlin, Germany; (A.S.); (M.L.); (G.B.)
| | - Melanie Liu
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Berlin Institute of Health, Freie Universität Berlin, 10117 Berlin, Germany; (A.S.); (M.L.); (G.B.)
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Tobias Faizy
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Elif Can
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (E.C.); (B.H.); (T.P.)
| | - Peter B. Sporns
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (E.C.); (B.H.); (T.P.)
| | - Tobias Penzkofer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (E.C.); (B.H.); (T.P.)
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| | - Georg Bohner
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Berlin Institute of Health, Freie Universität Berlin, 10117 Berlin, Germany; (A.S.); (M.L.); (G.B.)
| | - Frieder Schlunk
- BIH Biomedical Innovation Academy, Berlin Institute of Health (BIH), 10178 Berlin, Germany;
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Berlin Institute of Health, Freie Universität Berlin, 10117 Berlin, Germany; (A.S.); (M.L.); (G.B.)
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany; (S.E.); (H.K.); (R.M.); (G.B.); (P.B.S.); (J.F.); (U.H.)
| |
Collapse
|
33
|
Li YL, Lv XN, Wei X, Yang WS, Li R, Deng L, Wei M, Li Q, Lv FJ. Relationship Between Non-contrast Computed Tomography Imaging Markers and Perihemorrhagic Edema Growth in Intracerebral Hemorrhage. Neurocrit Care 2021; 35:451-456. [PMID: 33942209 DOI: 10.1007/s12028-021-01188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Perihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth. METHODS ICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear regression was constructed to study the relationship between NCCT imaging markers and PHE growth over 36 h. RESULTS A total of 214 patients were included. Nonparametric test showed that PHE volume was significantly different between patients with and without NCCT imaging markers. (all p < 0.05) In multivariable linear regression analysis adjusted for ICH characteristics, blend sign (p = 0.011), black hole sign (p = 0.002), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001) were correlated with PHE growth. Follow-up PHE volume within 36 h after baseline CT scan was associated with blend sign (p = 0.001), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001). CONCLUSION NCCT imaging markers of hematoma expansion are associated with PHE growth. This suggests that early PHE growth can be predicted using radiology markers on admission CT scan.
Collapse
Affiliation(s)
- Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao Wei
- Department of Traditional Chinese Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Miao Wei
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
34
|
Leasure AC, Kuohn LR, Vanent KN, Bevers MB, Kimberly WT, Steiner T, Mayer SA, Matouk CC, Sansing LH, Falcone GJ, Sheth KN. Association of Serum IL-6 (Interleukin 6) With Functional Outcome After Intracerebral Hemorrhage. Stroke 2021; 52:1733-1740. [PMID: 33682454 PMCID: PMC8085132 DOI: 10.1161/strokeaha.120.032888] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES IL-6 (interleukin 6) is a proinflammatory cytokine and an established biomarker in acute brain injury. We sought to determine whether admission IL-6 levels are associated with severity and functional outcome after spontaneous intracerebral hemorrhage (ICH). METHODS We performed an exploratory analysis of the recombinant activated FAST trial (Factor VII for Acute ICH). Patients with admission serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6 and 90-day modified Rankin Scale. In secondary analyses, we used linear regression to evaluate the association between IL-6 and baseline ICH and perihematomal edema volumes. RESULTS Of 841 enrolled patients, we included 552 (66%) with available admission IL-6 levels (mean age 64 [SD 13], female sex 203 [37%]). IL-6 was associated with poor outcome (modified Rankin Scale, 4-6; per additional 1 ng/L, odds ratio, 1.30 [95% CI, 1.04-1.63]; P=0.02) after adjustment for known predictors of outcome after ICH and treatment group. IL-6 was associated with ICH volume after adjustment for age, sex, and ICH location, and this association was modified by location (multivariable interaction, P=0.002), with a stronger association seen in lobar (β, 12.51 [95% CI, 6.47-18.55], P<0.001) versus nonlobar (β 5.32 [95% CI, 3.36-7.28], P<0.001) location. IL-6 was associated with perihematomal edema volume after adjustment for age, sex, ICH volume, and ICH location (β 1.22 [95% CI, 0.15-2.29], P=0.03). Treatment group was not associated with IL-6 levels or outcome. CONCLUSIONS In the FAST trial population, higher admission IL-6 levels were associated with worse 90-day functional outcome and larger ICH and perihematomal edema volumes.
Collapse
Affiliation(s)
- Audrey C. Leasure
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Lindsey R. Kuohn
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin N. Vanent
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew B. Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - W. Taylor Kimberly
- Department of Neurology, Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan A. Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Westchester Medical Center Health Network, Valhalla, NY, USA
| | - Charles C. Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven CT, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
35
|
Hannah TC, Kellner R, Kellner CP. Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review. Diagnostics (Basel) 2021; 11:diagnostics11030576. [PMID: 33806790 PMCID: PMC8005063 DOI: 10.3390/diagnostics11030576] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.
Collapse
|
36
|
Li Z, Li M, Shi SX, Yao N, Cheng X, Guo A, Zhu Z, Zhang X, Liu Q. Brain transforms natural killer cells that exacerbate brain edema after intracerebral hemorrhage. J Exp Med 2021; 217:152062. [PMID: 32870258 PMCID: PMC7526480 DOI: 10.1084/jem.20200213] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/13/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
Perihematomal edema (PHE) occurs within hours after intracerebral hemorrhage (ICH), leading to secondary injury manifested by impaired blood–brain barrier (BBB) integrity and destruction of adjacent tissue. To dissect the mechanisms underlying PHE formation, we profiled human and mouse perihematomal tissues and identified natural killer (NK) cells as the predominant immune cell subset that outnumbers other infiltrating immune cell types during early stages of ICH. Unbiased clustering of single-cell transcriptional profiles revealed two major NK cell subsets that respectively possess high cytotoxicity or robust chemokine production features in the brain after ICH, distinguishing them from NK cells of the periphery. NK cells exacerbate BBB disruption and brain edema after ICH via cytotoxicity toward cerebral endothelial cells and recruitment of neutrophils that augment focal inflammation. Thus, brain-bound NK cells acquire new features that contribute to PHE formation and neurological deterioration following ICH.
Collapse
Affiliation(s)
- Zhiguo Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,National Clinical Research Center for Neurological Disease of China, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Minshu Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,National Clinical Research Center for Neurological Disease of China, Jing-Jin Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Samuel X Shi
- Interdisciplinary Neuroscience Graduate Program, Arizona State University, Tempe, AZ
| | - Nan Yao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaojing Cheng
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ai Guo
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zilong Zhu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiaoan Zhang
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qiang Liu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
37
|
Wilkinson CM, Kung TF, Jickling GC, Colbourne F. A translational perspective on intracranial pressure responses following intracerebral hemorrhage in animal models. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
38
|
Li Y, Zhou H, Yang X, Zheng J, Zhang F, Xu M, Li H. Neck Circumference Is Associated With Poor Outcome in Patients With Spontaneous Intracerebral Hemorrhage. Front Neurol 2021; 11:622476. [PMID: 33597913 PMCID: PMC7882541 DOI: 10.3389/fneur.2020.622476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: This study aimed to assess the association between neck circumference (NC) and functional outcome in intracerebral hemorrhage (ICH) patients. Methods: We prospectively analyzed data from ICH patients who received treatment at our institution from January 2018 to November 2019. Patients were categorized into two groups according to 180-day modified Rankin scale (MRS) scores. Univariate and multivariate analyses were performed to assess whether NC was associated with poor outcome in ICH patients. Receiver operating characteristic (ROC) curve analysis was performed to determine the significance of NC in predicting the functional outcome of ICH patients. Results: A total of 312 patients were enrolled in our study. Multivariate logistic regression analysis indicated that NC was an independent predictor of poor 180-day functional outcome [odds ratio (OR) = 1.205, 95% confidence interval (CI): 1.075–1.350, p = 0.001]. ROC analysis revealed that NC could predict poor functional outcome at 6 months. Conclusions: NC is an independent predictor of unfavorable functional outcome at 6 months in ICH patients.
Collapse
Affiliation(s)
- Yujian Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huiqing Zhou
- Department of Intensive Care Unit, Fourth People's Hospital of Sichuan Province, Chengdu, China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mangmang Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
39
|
Deep learning shows good reliability for automatic segmentation and volume measurement of brain hemorrhage, intraventricular extension, and peripheral edema. Eur Radiol 2021; 31:5012-5020. [PMID: 33409788 DOI: 10.1007/s00330-020-07558-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/25/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate for the first time the performance of a deep learning method based on no-new-Net for fully automated segmentation and volumetric measurements of intracerebral hemorrhage (ICH), intraventricular extension of intracerebral hemorrhage (IVH), and perihematomal edema (PHE) in primary ICH on CT. METHODS Three hundred and eighty primary ICH patients who underwent CT at hospital arrival were divided into a training cohort (n = 300) and a validation cohort (n = 80). An independent cohort with 80 patients was used for testing. Ground truth (segmentation masks) was manually generated by radiologists. Model performance on lesion segmentation and volumetric measurement of ICH, IVH, and PHE were evaluated by comparing the model results with the segmentations performed by radiologists. RESULTS In the test cohort, the Dice scores of lesion segmentation were 0.92, 0.79, and 0.71 for ICH, IVH, and PHE, respectively. The sensitivities were 0.93 for ICH, 0.88 for IVH, and 0.81 for PHE. The positive predictive values were 0.92, 0.76, and 0.69 for ICH, IVH, and PHE, respectively. Excellent concordance (concordance correlation coefficients [CCCs] ≥ 0.98) of ICH and IVH and good concordance of PHE (CCCs ≥ 0.92) were demonstrated between manually and automatically measured volumes. The model took approximately 15 s to provide automatic segmentation and volume analysis for each patient. CONCLUSION Our model demonstrates good reliability for automatic segmentation and volume measurement of ICH, IVH, and PHE in primary ICH, which can be useful to reduce the effort and time of doctors to calculate volumes of ICH, IVH, and PHE. KEY POINTS • Deep learning algorithms can provide automatic and reliable assessment of intracerebral hemorrhage, intraventricular hemorrhage, and perihematomal edema on CT. • Non-contrast CT-based deep learning method can be helpful to provide efficient and accurate measurements of ICH, IVH, and PHE in primary ICH patients, thereby reducing the effort and time of doctors to segment and calculate volumes of ICH, IVH, and PHE in primary ICH patients.
Collapse
|
40
|
Shirazian A, Peralta-Cuervo AF, Aguilera-Pena MP, Cannizzaro L, Tran V, Nguyen D, Iwuchukwu I. Sustained Low-Efficiency Dialysis is Associated with Worsening Cerebral Edema and Outcomes in Intracerebral Hemorrhage. Neurocrit Care 2021; 35:221-231. [PMID: 33403579 DOI: 10.1007/s12028-020-01155-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES We postulated that renal replacement therapy (RRT) in ICH patients with advanced chronic kidney disease (CKD) is associated with increased frequency and size of perihematomal edema (PHE) expansion and worse patient outcomes. METHODS The Get With the Guidelines-Stroke Registry was queried for all patients admitted with ICH (N = 1089). Secondary causes, brainstem ICH, and initial HV < 7 cc were excluded. We identified patients with advanced CKD with and without RRT following admission for ICH. ABC/2 formula was used to measure hematoma volume (HV) and PHE. Patient outcomes were 30-day mortality, 90-day modified Rankin Scale score, and discharge disposition. We used propensity scores and optimal matching to adjust for multiple covariates. RESULTS At 48 h post-ICH, PHE expansion was a significant predictor of poor patient outcomes in our cohort. Patients with CKD who received sustained low-efficacy dialysis (SLED) treatment had larger 48 h PHE growth compared to both untreated CKD group (average treatment effect (ATE), 11.5; 95% CI, 4.9-18.1; p < 0.01) and all untreated patients (ATE, 7.43; 95% CI, 4.7-10.2; p < 0.01). Moreover, patients with RRT had significantly worse functional and mortality outcomes. CONCLUSIONS SLED treatment in ICH patients with CKD was associated with significant increase in rate and frequency of PHE expansion. Absolute increase in PHE during 48-h post-ICH was associated with increased mortality and worse functional outcomes. Further prospective and multicenter evaluation is needed to differentiate the effects of RRT on hematoma dynamics and patient outcomes from those attributed to CKD.
Collapse
Affiliation(s)
- Alireza Shirazian
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
| | | | | | | | - Vi Tran
- University of South Alabama School of Medicine, Mobile, AL, USA
| | - Doan Nguyen
- Institute for Translational Research, Ochsner Medical Center, Jefferson, LA, USA
| | - Ifeanyi Iwuchukwu
- Ochsner Clinical School, The University of Queensland, Jefferson, LA, USA
| |
Collapse
|
41
|
Sato T, Nishiyama Y, Suda S, Shimoyama T, Takahashi S, Sakamoto Y, Aoki J, Suzuki K, Sekine T, Kumita SI, Kimura K. "Computed Tomography Perihematomal Rims": A Perihematomal Low-Density Area Is a Part of an Acute Brain Hemorrhage. Intern Med 2021; 60:2395-2403. [PMID: 34334590 PMCID: PMC8381191 DOI: 10.2169/internalmedicine.6653-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.
Collapse
Affiliation(s)
- Takahiro Sato
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takashi Shimoyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shiro Takahashi
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kentaro Suzuki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Tetsuro Sekine
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| |
Collapse
|
42
|
Molecular Correlates of Hemorrhage and Edema Volumes Following Human Intracerebral Hemorrhage Implicate Inflammation, Autophagy, mRNA Splicing, and T Cell Receptor Signaling. Transl Stroke Res 2020; 12:754-777. [PMID: 33206327 PMCID: PMC8421315 DOI: 10.1007/s12975-020-00869-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/02/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022]
Abstract
Intracerebral hemorrhage (ICH) and perihematomal edema (PHE) volumes are major determinants of ICH outcomes as is the immune system which plays a significant role in damage and repair. Thus, we performed whole-transcriptome analyses of 18 ICH patients to delineate peripheral blood genes and networks associated with ICH volume, absolute perihematomal edema (aPHE) volume, and relative PHE (aPHE/ICH; rPHE). We found 440, 266, and 391 genes correlated with ICH and aPHE volumes and rPHE, respectively (p < 0.005, partial-correlation > |0.6|). These mainly represented inflammatory pathways including NF-κB, TREM1, and Neuroinflammation Signaling-most activated with larger volumes. Weighted Gene Co-Expression Network Analysis identified seven modules significantly correlated with these measures (p < 0.05). Most modules were enriched in neutrophil, monocyte, erythroblast, and/or T cell-specific genes. Autophagy, apoptosis, HIF-1α, inflammatory and neuroinflammatory response (including Toll-like receptors), cell adhesion (including MMP9), platelet activation, T cell receptor signaling, and mRNA splicing were represented in these modules (FDR p < 0.05). Module hub genes, potential master regulators, were enriched in neutrophil-specific genes in three modules. Hub genes included NCF2, NCF4, STX3, and CSF3R, and involved immune response, autophagy, and neutrophil chemotaxis. One module that correlated negatively with ICH volume correlated positively with rPHE. Its genes and hubs were enriched in T cell-specific genes including hubs LCK and ITK, Src family tyrosine kinases whose modulation improved outcomes and reduced BBB dysfunction following experimental ICH. This study uncovers molecular underpinnings associated with ICH and PHE volumes and pathophysiology in human ICH, where knowledge is scarce. The identified pathways and hub genes may represent novel therapeutic targets.
Collapse
|
43
|
The Hounsfield Unit of Perihematomal Edema Is Associated With Poor Clinical Outcomes in Intracerebral Hemorrhage. World Neurosurg 2020; 146:e829-e836. [PMID: 33189917 DOI: 10.1016/j.wneu.2020.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hounsfield unit (HU) of perihematomal edema (PHE) may be a predictor of prognosis of intracerebral hemorrhage (ICH). Our study evaluated whether PHE mean HU at the 72 hours after ICH predicts outcome, and how it compares against other PHE measures. METHODS Patients with ICH from a tertiary medical institution were included. PHE was segmented by the semiautomatic plane method to measure volume and mean HU. Outcomes of interest was poor 90-day prognosis (modified Rankin Scale score ≥3). Logistic regression was used to assess relationships with outcome. RESULTS Data from a total of 159 patients with ICH were collected. The median mean HU of PHE at 72 hours was 22.1 (IQR: 19.2-25.0). Binary logistic regression showed that the 72-hour PHE mean HU was negatively correlated with the poor prognosis of patients with ICH (OR 0.59, 95% CI 0.47-0.75, P < 0.05). The receiver operator curves of meaningful indicators revealed that the area under the curve (AUC) of PHE mean HU at 72 hours was larger and the difference of AUC between PHE mean HU with PHE absolute volume or extension distance were statistically significant (P < 0.05). The 72-hour PHE mean HU has a higher value in predicting adverse prognosis of patients with ICH. CONCLUSIONS The PHE mean HU at 72 hours was negatively correlated with the poor prognosis of patients with ICH. The prediction ability of PHE mean HU at 72 hours was better than PHE absolute volume and extension distance, contributing to a rather good index for predicting outcome of ICH.
Collapse
|
44
|
Rationale and Design of a Randomized, Double-Blind Trial Evaluating the Efficacy of Tranexamic Acid on Hematoma Expansion and Peri-hematomal Edema in Patients with Spontaneous Intracerebral Hemorrhage within 4.5 h after Symptom Onset: The THE-ICH Trial Protocol. J Stroke Cerebrovasc Dis 2020; 29:105136. [PMID: 32912508 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hematoma expansion (HE) and peri-hematomal edema (PHE) are associated with adverse outcomes of patients with acute spontaneous intracerebral hemorrhage (sICH). Due to a lack of proven treatments, it is critical to explore novel treatments for HE and PHE to improve functional recovery after sICH. METHODS This is a prospective, multicenter, placebo-controlled, double-blind, and randomized clinical study of approximately 2400 patients with sICH. Patients within 4.5 h of sICH onset that fulfilling the clinical criteria for diagnosis (e.g. age more than 18 years old, the Glasgow Coma Scal>7, and no planned surgery) will randomly receive either intravenous tranexamic acid (TXA) 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo (sodium chloride 0.9%). Clinical data including the ICH score and the Glasgow Coma Scale score will be collected on admission. After assessment of HE and PHE expansion, follow-up will be conducted with enrolled patients for 90 days. RESULTS Primary outcome metrics are HE (defined as either >33% or >6 ml increase from baseline) and PHE expansion rate at 24 ± 3 h and 72 ± 3 h post-sICH. Secondary outcome metrics include mortality and the modified Rankin Scale on day 90 after sICH. Appropriate statistic methods will be used to evaluate the efficacy of TXA on patients with sICH within 4.5 h of symptom onset. CONCLUSIONS HE usually occurs within the first few hours after onset of symptoms. It is essential to evaluate the efficacy of TXA on HE within a narrow window of time. This will be the first trial to evaluate the efficacy of TXA on HE and PHE expansion in sICH patients within 4.5 h after symptom onset. This trial is registered as ChiCTR1900027065 at http://www.chictr.org.cn.
Collapse
|
45
|
Corry JJ, Asaithambi G, Shaik AM, Lassig JP, Marino EH, Ho BM, Castle AL, Banerji N, Tipps ME. Conivaptan for the Reduction of Cerebral Edema in Intracerebral Hemorrhage: A Safety and Tolerability Study. Clin Drug Investig 2020; 40:503-509. [PMID: 32253717 DOI: 10.1007/s40261-020-00911-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) growth in intracranial hemorrhage (ICH) is a biomarker for worse outcomes. Although the management of PHE is potentially beneficial for ICH patients, there is currently no proven clinical therapy that both reduces PHE and improves outcomes in this population. OBJECTIVE To examine the safety and tolerability of conivaptan, a non-peptide vasopressin (AVP) receptor antagonist, for the management of PHE in ICH patients. METHODS We performed a single-center, open-label, phase I study in seven patients with ICH at risk for developing PHE. Conivaptan (20 mg) was administered every 12 h for 2 days, along with the standard ICH management. Electrolyte levels, renal and cardiac function, and vital signs were monitored throughout treatment. Neurological status, ICH, and PHE volumes were assessed at study baseline, 24 h, 72 h, and 7 days from the first conivaptan administration, as well as at the 3-month follow-up. RESULTS Conivaptan was well tolerated in our patients. We observed the expected increase in sodium levels following conivaptan administration (p = 0.01), with no change in cardiac or renal function. All patients survived to follow-up, and adverse event rates were comparable with those of the neurocritical care unit overall. CONCLUSIONS These data indicate that conivaptan can be safely administered to ICH patients and support further clinical investigation into the efficacy of this drug for ICH treatment. CLINICAL TRIAL REGISTRATION clinicaltrials.gov; NCT03000283, 22 December 2016.
Collapse
Affiliation(s)
- Jesse J Corry
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA.
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA.
| | - Ganesh Asaithambi
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Arif M Shaik
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Jeffrey P Lassig
- Midwest Radiology, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Emily H Marino
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Bridget M Ho
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Amy L Castle
- John Nasseff Neuroscience Specialty Clinic, United Hospital Part of Allina Health, 310 Smith Ave N, MR 64440, Ritchie Building, Suite 440, Saint Paul, MN, 55102, USA
- Department of Neurosciences, United Hospital Part of Allina Health, Saint Paul, MN, USA
| | - Nilanjana Banerji
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Megan E Tipps
- Neuroscience Research, United Hospital Part of Allina Health, Saint Paul, MN, USA
- Neuroscience Research, Abbott Northwestern Hospital, Minneapolis, MN, USA
| |
Collapse
|
46
|
Hervella P, Rodríguez-Yáñez M, Pumar JM, Ávila-Gómez P, da Silva-Candal A, López-Loureiro I, Rodríguez-Maqueda E, Correa-Paz C, Castillo J, Sobrino T, Campos F, Iglesias-Rey R. Antihyperthermic treatment decreases perihematomal hypodensity. Neurology 2020; 94:e1738-e1748. [PMID: 32221027 PMCID: PMC7282877 DOI: 10.1212/wnl.0000000000009288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/21/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect on perihematomal hypodensity and outcome of a decrease in body temperature in the first 24 hours in patients with intracerebral hemorrhage (ICH). METHODS In this retrospective study on a prospectively registered database, among the 1,100 patients, 795 met all the inclusion criteria. Temperature variations in the first 24 hours and perihematomal hypodensity (PHHD) were recorded. Patients ≥37.5°C were treated with antihyperthermic drugs for at least 48 hours. The main objective was to determine the association among temperature variation, PHHD, and outcome at 3 months. RESULTS The decrease in temperature in the first 24 hours increased the possibility of good outcome 11-fold. Temperature decrease, lower PHHD volume, and a good outcome were observed in 31.8% of the patients who received antihyperthermic treatment. CONCLUSION The administration of early antihyperthermic treatment in patients with spontaneous ICH with a basal axillary temperature ≥37.5°C resulted in good outcome in a third of the treated patients.
Collapse
Affiliation(s)
- Pablo Hervella
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain.
| | - Manuel Rodríguez-Yáñez
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - José Manuel Pumar
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Paulo Ávila-Gómez
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Andrés da Silva-Candal
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Ignacio López-Loureiro
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Elena Rodríguez-Maqueda
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Clara Correa-Paz
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - José Castillo
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Tomás Sobrino
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Francisco Campos
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- From the Clinical Neurosciences Research Laboratory (LINC) (P.H., P.Á.-G., A.d.S.-C., I.L.-L., E.R.-M., C.-C.P., J.C., T.S., F.C., R.I.-R.), Health Research Institute of Santiago de Compostela (IDIS); and Stroke Unit, Department of Neurology (M.R.-Y.), and Department of Neuroradiology (J.M.P.), Hospital Clínico Universitario, Santiago de Compostela, Spain.
| |
Collapse
|
47
|
Halstead MR, Mould WA, Sheth KN, Rosand J, Thompson R, Levy A, Hanley DF, Goldstein JN, Nyquist P. Haptoglobin is associated with increased early perihematoma edema progression in spontaneous intracranial hemorrhage. Int J Stroke 2020; 15:899-908. [PMID: 32264796 DOI: 10.1177/1747493020912602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Perihematomal edema in intracranial hemorrhage is influenced by free hemoglobin clearance and inflammation. Serum Haptoglobin (Hp) binds free hemoglobin, affecting heme clearance and free radical production. Of the three Hp phenotypes, Hp 1-1 has the greatest effect on free hemoglobin clearance. AIM To determine if individuals with Hp 1-1 phenotype have different rates of early perihematomal edema formation as compared to those with Hp 2-1 and Hp 2-2. METHODS We determined Hp phenotype, intracranial hemorrhage volume, and rate of early change in perihematomal volume in participants from three prospectively collected intracranial hemorrhage cohorts. The association of Hp phenotypes 1-1, 2-1, 2-2, with early change in perihematomal volume, while controlling for key clinical characteristics was analyzed using a multivariate model. FINDINGS One-hundred and sixty-six participants were included: 73 (44%) female, 41 ( 25%) African Americans, 34 (20%) diabetics, 133 (80%) with hypertension, and 75 (45%) active smokers. There were 15 subjects with Hp phenotype 1-1, 86 with 2-1, and 65 with 2-2. In fully adjusted analysis, Hp 1-1 had a significantly increased estimated mean rate of early change in perihematomal volume at 1.15 (95% confidence interval 0.58-1.71) as compared to all other Hp 2-1 or Hp 2-2 containing phenotypes (0.30, 95% confidence interval 0.06-0.54; 0.29 95% CI 0.02-0.56). Neither mortality nor discharge mRS differed between Hp phenotypes. CONCLUSION Haptoglobin phenotype is associated with early change in perihematomal volume. Hp 1-1 phenotype had significantly increased mean rate of early change in perihematomal volume within the first 96 h, suggesting that haptoglobin phenotype may be a key player in understanding the multiphasic progression of perihematomal volume in spontaneous intracerebral hemorrhage. A larger prospective observational study is warranted.
Collapse
Affiliation(s)
- Michael R Halstead
- Departments of Neurology, Anesthesiology Critical Care Medicine and Neurosurgery, Johns Hopkins Hospital, Neurosciences Critical Care Division, Baltimore MD, USA
| | - W Andrew Mould
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Levy
- Bruce Rappaport Technion Faculty of Medicine, Haifa, Israel
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Nyquist
- Department of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
48
|
Ironside N, Chen CJ, Mutasa S, Sim JL, Ding D, Marfatiah S, Roh D, Mukherjee S, Johnston KC, Southerland AM, Mayer SA, Lignelli A, Connolly ES. Fully Automated Segmentation Algorithm for Perihematomal Edema Volumetry After Spontaneous Intracerebral Hemorrhage. Stroke 2020; 51:815-823. [PMID: 32078476 DOI: 10.1161/strokeaha.119.026764] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Perihematomal edema (PHE) is a promising surrogate marker of secondary brain injury in patients with spontaneous intracerebral hemorrhage, but it can be challenging to accurately and rapidly quantify. The aims of this study are to derive and internally validate a fully automated segmentation algorithm for volumetric analysis of PHE. Methods- Inpatient computed tomography scans of 400 consecutive adults with spontaneous, supratentorial intracerebral hemorrhage enrolled in the Intracerebral Hemorrhage Outcomes Project (2009-2018) were separated into training (n=360) and test (n=40) datasets. A fully automated segmentation algorithm was derived from manual segmentations in the training dataset using convolutional neural networks, and its performance was compared with that of manual and semiautomated segmentation methods in the test dataset. Results- The mean volumetric dice similarity coefficients for the fully automated segmentation algorithm were 0.838±0.294 and 0.843±0.293 with manual and semiautomated segmentation methods as reference standards, respectively. PHE volumes derived from the fully automated versus manual (r=0.959; P<0.0001), fully automated versus semiautomated (r=0.960; P<0.0001), and semiautomated versus manual (r=0.961; P<0.0001) segmentation methods had strong between-group correlations. The fully automated segmentation algorithm (mean 18.0±1.8 seconds/scan) quantified PHE volumes at a significantly faster rate than both of the manual (mean 316.4±168.8 seconds/scan; P<0.0001) and semiautomated (mean 480.5±295.3 seconds/scan; P<0.0001) segmentation methods. Conclusions- The fully automated segmentation algorithm accurately quantified PHE volumes from computed tomography scans of supratentorial intracerebral hemorrhage patients with high fidelity and greater efficiency compared with manual and semiautomated segmentation methods. External validation of fully automated segmentation for assessment of PHE is warranted.
Collapse
Affiliation(s)
- Natasha Ironside
- From the Department of Neurological Surgery (N.I., C.-J.C.), University of Virginia Health System, Charlottesville, VA
| | - Ching-Jen Chen
- From the Department of Neurological Surgery (N.I., C.-J.C.), University of Virginia Health System, Charlottesville, VA
| | - Simukayi Mutasa
- Department of Radiology (S. Mutasa, S. Marfatiah, A. Lignelli), Columbia University Irving Medical Center, New York
| | - Justin L Sim
- Department of Neurological Surgery (J.L.S., E.S.C.), Columbia University Irving Medical Center, New York
| | - Dale Ding
- Department of Neurological Surgery, University of Louisville School of Medicine, KY (D.D.)
| | - Saurabh Marfatiah
- Department of Radiology (S. Mutasa, S. Marfatiah, A. Lignelli), Columbia University Irving Medical Center, New York
| | - David Roh
- Department of Neurology (D.R.), Columbia University Irving Medical Center, New York
| | - Sugoto Mukherjee
- Department of Radiology (S. Mukherjee), University of Virginia Health System, Charlottesville, VA
| | - Karen C Johnston
- Department of Neurology (K.C.J., A.M.S.), University of Virginia Health System, Charlottesville, VA
| | - Andrew M Southerland
- Department of Neurology (K.C.J., A.M.S.), University of Virginia Health System, Charlottesville, VA
| | - Stephan A Mayer
- Department of Neurology, Henry Ford Health System, Detroit, MI (S.A.M.)
| | - Angela Lignelli
- Department of Radiology (S. Mutasa, S. Marfatiah, A. Lignelli), Columbia University Irving Medical Center, New York
| | - Edward Sander Connolly
- Department of Neurological Surgery (J.L.S., E.S.C.), Columbia University Irving Medical Center, New York
| |
Collapse
|
49
|
Gusdon AM, Nyquist PA, Torres-Lopez VM, Leasure AC, Falcone GJ, Sheth KN, Sansing LH, Hanley DF, Malani R. Perihematomal Edema After Intracerebral Hemorrhage in Patients With Active Malignancy. Stroke 2019; 51:129-136. [PMID: 31744426 DOI: 10.1161/strokeaha.119.027085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background and Purpose- Patients with active malignancy are at risk for intracerebral hemorrhage (ICH). We aimed to characterize perihematomal edema (PHE) and hematoma volumes after spontaneous nontraumatic ICH in patients with cancer without central nervous system involvement. Methods- Patients with active malignancy who developed ICH were retrospectively identified through automated searches of institutional databases. Control patients were identified with ICH and without active cancer. Demographic and cancer-specific data were obtained by chart review. Hematoma and PHE volumes were determined using semiautomated methodology. Univariate and multivariate linear regression models were created to assess which variables were associated with hematoma and PHE expansion. Results- Patients with cancer (N=80) and controls (N=136) had similar demographics (all P>0.20), although hypertension was more prevalent among controls (P=0.004). Most patients with cancer had received recent chemotherapy (n=45, 56%) and had recurrence of malignancy (n=43, 54%). Patients with cancer were thrombocytopenic (median platelet count 90 000 [interquartile range, 17 500-211 500]), and most had undergone blood product transfusion (n=41, 51%), predominantly platelets (n=38, 48%). Thirty-day mortality was 36% (n=29). Patients with cancer had significantly increased PHE volumes (23.67 versus 8.61 mL; P=1.88×10-9) and PHE-to-ICH volume ratios (2.26 versus 0.99; P=2.20×10-16). In multivariate analyses, variables associated with PHE growth among patients with cancer were ICH volume (β=1.29 [95% CI, 1.58-1.30] P=1.30×10-5) and platelet transfusion (β=15.67 [95% CI, 3.61-27.74] P=0.014). Variables associated with 30-day mortality were ICH volume (odds ratio, 1.06 [95% CI, 1.03-1.10] P=6.76×10-5), PHE volume (odds ratio, 1.07 [95% CI, 1.04-1.09] P=7.40×10-6), PHE growth (odds ratio, 1.05 [95% CI, 1.01-1.10] P=0.01), and platelet transfusion (odds ratio, 1.48 [95% CI, 1.22-1.79] P=0.0001). Conclusions- Patients with active cancer who develop ICH have increased PHE volumes. PHE growth was independent of thrombocytopenia but associated with blood product transfusion. Thirty-day mortality was associated with PHE and ICH volumes and blood product transfusion.
Collapse
Affiliation(s)
- Aaron M Gusdon
- From the Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.M.G., P.A.N.)
| | - Paul A Nyquist
- From the Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.M.G., P.A.N.).,Division of Brain Injury Outcomes (BIOS), Johns Hopkins University School of Medicine, Baltimore, MD (P.A.N., D.F.H.)
| | - Victor M Torres-Lopez
- Department of Neurology, Yale University School of Medicine, New Haven, CT (V.M.T.-L., A.C.L., G.J.F., K.N.S., L.H.S.)
| | - Audrey C Leasure
- Department of Neurology, Yale University School of Medicine, New Haven, CT (V.M.T.-L., A.C.L., G.J.F., K.N.S., L.H.S.)
| | - Guido J Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT (V.M.T.-L., A.C.L., G.J.F., K.N.S., L.H.S.)
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT (V.M.T.-L., A.C.L., G.J.F., K.N.S., L.H.S.)
| | - Lauren H Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT (V.M.T.-L., A.C.L., G.J.F., K.N.S., L.H.S.)
| | - Daniel F Hanley
- Division of Brain Injury Outcomes (BIOS), Johns Hopkins University School of Medicine, Baltimore, MD (P.A.N., D.F.H.)
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY (R.M.)
| |
Collapse
|
50
|
Halstead MR, Geocadin RG. The Medical Management of Cerebral Edema: Past, Present, and Future Therapies. Neurotherapeutics 2019; 16:1133-1148. [PMID: 31512062 PMCID: PMC6985348 DOI: 10.1007/s13311-019-00779-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cerebral edema is commonly associated with cerebral pathology, and the clinical manifestation is largely related to the underlying lesioned tissue. Brain edema usually amplifies the dysfunction of the lesioned tissue and the burden of cerebral edema correlates with increased morbidity and mortality across diseases. Our modern-day approach to the medical management of cerebral edema has largely revolved around, an increasingly artificial distinction between cytotoxic and vasogenic cerebral edema. These nontargeted interventions such as hyperosmolar agents and sedation have been the mainstay in clinical practice and offer noneloquent solutions to a dire problem. Our current understanding of the underlying molecular mechanisms driving cerebral edema is becoming much more advanced, with differences being identified across diseases and populations. As our understanding of the underlying molecular mechanisms in neuronal injury continues to expand, so too is the list of targeted therapies in the pipeline. Here we present a brief review of the molecular mechanisms driving cerebral edema and a current overview of our understanding of the molecular targets being investigated.
Collapse
Affiliation(s)
- Michael R Halstead
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology-Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA.
| | - Romergryko G Geocadin
- Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology-Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287, USA
| |
Collapse
|