QSM predicts haemorrhage risk in brainstem cavernous malformations: a multicentre prospective study.

IF 8.7 1区 医学 Q1 CLINICAL NEUROLOGY
Si-Hui Wang, Hong-Wei Li, Jian-Cong Weng, Yan-Bing Yu, Gui-Jun Zhang, Bo-Han Yao, Pan-Pan Liu, Lu Kong, Hui Zhou, Hao-Yu Zhang, Xiao-Jun Zeng, Ze-Yu Wu, Cong Ren, Wei Wang, Hong-Jun Zhang, Jun-Peng Ma, Xiao-Ying Xu, Lai-Rong Song, Jun-Ting Zhang, Zhen Wu, Liang Wang, Sheng-Jun Sun, Da Li
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Abstract

Background: This study investigates the predictive value of baseline quantitative susceptibility mapping (QSM) metrics for assessing the risk of future symptomatic haemorrhages in patients with brainstem cavernous malformations (CMs).

Methods: From July 2020 to September 2023, a prospective multicentre cohort of 155 patients with brainstem CMs was enrolled from 12 institutions. We analysed baseline QSM metrics, including lesional mean, median, IQR and maximum susceptibility. Propensity score matching was adjusted for baseline confounders, and Cox regression models assessed haemorrhage risk. Risk stratification was performed based on thresholds determined from planned receiver operating characteristic (ROC) analyses.

Results: Postmatching cohorts (56 haemorrhage-free vs 30 haemorrhage cases) showed balanced baseline characteristics. Over a mean follow-up of 22.6 months, the baseline QSM metrics, particularly the median susceptibility (QSMmedian) (HR 58.896, 95% CI 8.544 to 405.989, p<0.001; Bonferroni-adjusted p=0.0001, k=4) and IQR of susceptibility (QSMIQR) (HR 29.754, 95% CI 6.101 to 145.119, p<0.001; Bonferroni-adjusted p=0.0001, k=4) were associated with prospective haemorrhage after adjusting for age, gender, lesion volume and prior haemorrhage. QSMmedian (area under curve (AUC)=0.759) and QSMIQR (AUC=0.740) demonstrated modest predictive performance. Risk stratification based on QSMmedian and QSMIQR demonstrated 2-year haemorrhage-free survival rates of 83.3%, 62.8% and 35.7% for the low-risk, intermediate-risk and high-risk groups, respectively. High-risk patients showed a 7.7-fold greater risk of haemorrhage compared with the low-risk group.

Conclusions: This study explored the predictive value of QSM metrics for future symptomatic haemorrhage, suggesting that QSM may serve as a complementary imaging biomarker to existing prognostic models. Further validation in larger, independent cohorts is warranted.

QSM预测脑干海绵状血管瘤出血风险:一项多中心前瞻性研究。
背景:本研究探讨了基线定量易感性制图(QSM)指标对评估脑干海绵状血管瘤(CMs)患者未来症状性出血风险的预测价值。方法:从2020年7月至2023年9月,来自12个机构的155例脑干CMs患者纳入前瞻性多中心队列。我们分析了基线QSM指标,包括病灶平均值、中位数、IQR和最大易感性。根据基线混杂因素调整倾向评分匹配,并用Cox回归模型评估出血风险。根据计划的受试者工作特征(ROC)分析确定的阈值进行风险分层。结果:配对后的队列(56例无出血vs 30例出血)显示平衡的基线特征。在平均22.6个月的随访中,基线QSM指标,特别是中位易感性(QSMmedian) (HR为58.896,95% CI为8.544 ~ 405.989)得出结论:本研究探讨了QSM指标对未来症状性出血的预测价值,表明QSM可作为现有预后模型的补充成像生物标志物。需要在更大的独立队列中进一步验证。
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来源期刊
CiteScore
15.70
自引率
1.80%
发文量
888
审稿时长
6 months
期刊介绍: The Journal of Neurology, Neurosurgery & Psychiatry (JNNP) aspires to publish groundbreaking and cutting-edge research worldwide. Covering the entire spectrum of neurological sciences, the journal focuses on common disorders like stroke, multiple sclerosis, Parkinson’s disease, epilepsy, peripheral neuropathy, subarachnoid haemorrhage, and neuropsychiatry, while also addressing complex challenges such as ALS. With early online publication, regular podcasts, and an extensive archive collection boasting the longest half-life in clinical neuroscience journals, JNNP aims to be a trailblazer in the field.
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