Evolution of Perihematomal Edema Mean Hounsfield Unit and Its Association with Clinical Outcome in Intracerebral Hemorrhage: A Post Hoc Analysis of the i-DEF Trial.
Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim
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引用次数: 0
Abstract
Background: Lower mean Hounsfield unit (mHU) values, indicating greater computed tomography (CT) hypodensity of perihematomal edema (PHE), have been proposed as a novel quantitative imaging marker in intracerebral hemorrhage (ICH). We explored its evolution and prognostic importance in a post hoc analysis of the Intracerebral Hemorrhage-Deferoxamine trial (NCT02175225).
Methods: We included participants with primary supratentorial ICH who had available CT scans at baseline and follow-up after 72-96 h and 90-days and/or 180-days outcome data. The primary exposure variable was the mHU of PHE measured on the follow-up CT scan. We investigated (1) its change from baseline and (2) its association with unfavorable outcome (modified Rankin Scale score 3-6) in adjusted mixed-effects models, accounting for between-center and between-participant variability.
Results: Among 273 of 293 Intracerebral Hemorrhage-Deferoxamine trial participants eligible for analysis (median age 61 years, 39% female), the median (interquartile range) mHU of PHE was 30.3 (28.3-32.7) at baseline and 26.9 (24.6-29.2) at follow-up. Τhe mHU of PHE decreased from baseline to follow-up scan by an average of 3.6 (95% confidence interval [CI] 3.2-4.0, p < 0.001). There was no association between the mHU of follow-up PHE with unfavorable outcome at 90 days (n = 273; odds ratio 1.05, 95% CI 0.95-1.17, p = 0.32), or at 180 days (n = 261; odds ratio 1.01, 95% CI 0.92-1.11, p = 0.81).
Conclusions: Perihematomal edema after ICH tends to grow more hypodense on CT by day 3-4 compared with baseline. The degree of PHE hypodensity was not associated with long-term clinical outcomes in the setting of a multicenter randomized trial, challenging its utility as a radiological marker in ICH research.
期刊介绍:
Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.