NCCT低密度和CTA斑点征的共定位预示着脑内血肿的实质性扩张：黑白征

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-08-16 DOI:10.1177/23969873241271745

Umberto Pensato, Koji Tanaka, MacKenzie Horn, Ericka Teleg, Abdulaziz Sulaiman Al Sultan, Linda Kasickova, Tomoyuki Ohara, Piyush Ojha, Sina Marzoughi, Ankur Banerjee, Girish Kulkarni, Dar Dowlatshahi, Mayank Goyal, Bijoy K Menon, Andrew M Demchuk

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引用次数: 0

摘要

背景：血肿扩大（HE）的现有放射学标志物显示出适度的预测准确性。我们旨在研究一种新型放射学标志物，它能将非对比 CT（NCCT）和 CT 血管造影（CTA）的结果共同定位，从而预测 HE：方法：纳入加拿大卡尔加里 Foothills 医疗中心收治的连续急性脑内出血患者。黑白征的定义是 CTA 上任何可视化识别的斑点征与相应 NCCT 上的低密度征共同定位。主要结果是血肿扩大（⩾6 mL 或 ⩾33%）。次要结果包括血肿增长绝对值（75%）：共纳入 200 例患者，其中 50 例（25%）出现高血压。44人（22%）出现斑点征，69人（34.5%）出现低密度征，14人（7%）同时出现黑白征。黑白征的患者中 HE 的比例较高（100% 对 19.4%，p p p 结论）：黑白征是血肿扩大发生和严重程度的可靠预测指标，但还需要进一步验证才能证实这些令人信服的发现。

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Co-localization of NCCT hypodensity and CTA spot sign predicts substantial intracerebral hematoma expansion: The Black-&-White sign.

Background: Existing radiological markers of hematoma expansion (HE) show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE.

Methods: Consecutive acute intracerebral hemorrhage patients admitted at Foothills Medical Centre in Calgary, Canada, were included. The Black-&-White sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT. The primary outcome was hematoma expansion (⩾6 mL or ⩾33%). Secondary outcomes included absolute (<3, 3-6, 6-12, ⩾12 mL) and relative (0%, <25%, 25%-50%, 50%-75%, or >75%) hematoma growth scales.

Results: Two-hundred patients were included, with 50 (25%) experiencing HE. Forty-four (22%) showed the spot sign, 69 (34.5%) the hypodensity sign, and 14 (7%) co-localized both as the Black-&-White sign. Those with the Black-&-White sign had higher proportions of HE (100% vs 19.4%, p < 0.001), greater absolute hematoma growth (23.37 mL (IQR = 15.41-30.27) vs 0 mL (IQR = 0-2.39), p < 0.001) and relative hematoma growth (120% (IQR = 49-192) vs 0% (0-15%), p < 0.001). The Black-&-White sign had a specificity of 100% (95%CI = 97.6%-100%), a positive predictive value of 100% (95%CI = 76.8%-100%), and an overall accuracy of 82% (95%CI = 76%-87.1%). Among the 14 patients with the Black-&-White sign, 13 showed an absolute hematoma growth ⩾12 mL, and 10 experienced a HE exceeding 75% of the initial volume. The inter-rater agreement was excellent (kappa coefficient = 0.84).

Conclusion: The Black-&-White sign is a robust predictor of hematoma expansion occurrence and severity, yet further validation is needed to confirm these compelling findings.

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.