脑出血患者血肿周围水肿平均Hounsfield单位的演变及其与临床结局的关系:i-DEF试验的事后分析

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim
{"title":"脑出血患者血肿周围水肿平均Hounsfield单位的演变及其与临床结局的关系:i-DEF试验的事后分析","authors":"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim","doi":"10.1007/s12028-025-02337-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov: NCT02175225.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Alexandros A Polymeris, Vasileios-Arsenios Lioutas, Diego Incontri, Salil Soman, Magdy H Selim\",\"doi\":\"10.1007/s12028-025-02337-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov: NCT02175225.</p>\",\"PeriodicalId\":19118,\"journal\":{\"name\":\"Neurocritical Care\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-08-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurocritical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12028-025-02337-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-025-02337-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:较低的平均Hounsfield单位(mHU)值,表明更大的计算机断层扫描(CT)低密度的血肿周围水肿(PHE),已被提出作为脑出血(ICH)的一种新的定量成像标记。我们在脑出血-去铁胺试验(NCT02175225)的事后分析中探讨了它的演变和预后重要性。方法:我们纳入了原发性幕上脑出血患者,他们在基线和随访72-96小时、90天和/或180天的结局数据时有可用的CT扫描。主要暴露变量是随访CT扫描测量的PHE的mHU。我们在调整后的混合效应模型中研究了(1)其与基线的变化(2)其与不良结果(修改的Rankin量表得分3-6)的关联,考虑了中心之间和参与者之间的可变性。结果:在293名符合分析条件的脑出血-去铁胺试验参与者中(中位年龄61岁,39%为女性),PHE的中位(四分位数范围)mHU在基线时为30.3(28.3-32.7),在随访时为26.9(24.6-29.2)。Τhe PHE的mHU从基线到随访扫描平均下降3.6(95%可信区间[CI] 3.2-4.0, p)。结论:与基线相比,脑出血后第3-4天的CT上血肿周围水肿倾向于变得更低密度。在一项多中心随机试验中,PHE低密度程度与长期临床结果无关,挑战了其作为脑出血研究放射标志物的实用性。临床试验注册:ClinicalTrials.gov: NCT02175225。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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.

Clinical trial registration: ClinicalTrials.gov: NCT02175225.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信