Impact of Intraventricular Hemorrhage on Classification of Hematoma Expansion and Development of Radiomics Prediction Models

Abstract Background: To investigate the impact of intraventricular hemorrhage (IVH) on the classification of hematoma expansion (HE), and the development of radiomics models using features extracted from the baseline hematoma to predict HE.Methods: Eighty-four patients with baseline and follow-up non-contrast CT within 4~24 hours were included. The intraparenchymal hemorrhage (IPH) and IVH were separately outlined by an experienced neuroradiologist. HE was defined as an absolute hematoma growth >6 mL or percentage growth >33%. HE was determined based on two criteria, using IPH alone (HEP) or IPH+IVH (HEP+V). The radiomics analysis was performed by using PyRadiomics to extract features, followed by random forest algorithm to select features, and lastly the decision tree to build classification models. Results: The classification of expansion showed 37 (44%) HEP and 47 (56%) non-HEP based on IPH alone, and similar results of 38 (45%) HEP+V and 46 (55%) non-HEP+V based on IPH+IVH. The majority, >94% of HE patients, had a poor outcome (death or mRS>3 at discharge). Three radiomics analysis (RA) models were built. The first model using baseline IPH to predict HEP (RAP-P) showed an accuracy of 80% but loss of correlation with the clinical outcome; the second model using IPH+IVH to predict HEP (RAPV-V) had a slightly higher accuracy of 81% and resumed the poor outcome association with HE; and the third model using IPH+IVH to predict HEP+V (RAPV-PV) had the highest accuracy of 86% with preserved clinical outcome correlation of HE. The sensitivity, specificity, and accuracy of three decision trees (RAP-P, RAPV-P, RAPV-PV) were 0.8/ 0.68/ 0.89; 0.81/ 0.92/ 0.72 and 0.86/ 0.82/ 0.89, respectively.Conclusions: The proposed radiomics approach with additional IVH information could be used to classify the expansion status highly associated with the clinical outcome and provide a robust tool for the enrollment of high-risk ICH cases in the anti-expansion trials.

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Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages

BioMed Research International ◽

10.1155/2021/9233559 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Lijing Deng ◽

Kai Chen ◽

Liu Yang ◽

Zhaoxu Deng ◽

Haijun Zheng

Keyword(s):

Basal Ganglia ◽

Functional Outcome ◽

Hematoma Expansion ◽

Short Term ◽

Poor Functional Outcome ◽

Predictive Values ◽

Relative Growth ◽

Poor Outcome ◽

Absolute Growth ◽

The Impact

Purpose. To investigate the impact of hematoma expansion (HE) on short-term functional outcome of patients with thalamic and basal ganglia intracerebral hemorrhage. Methods. Data of 420 patients with deep intracerebral hemorrhage (ICH) that received a baseline CT scan within 6 hours from symptom onset and a follow-up CT scan within 72 hours were retrospectively analyzed. The poor functional outcome was defined as modified Rankin score mRS > 3 at 30 days. Receiver operating characteristic (ROC) curves for relative and absolute growth of HE were generated and compared. Multivariable logistic regression models were used to analyze the impact of HE on the functional outcome in basal ganglia and thalamic hemorrhages. The predictive values for different thresholds of HE were calculated, and correlation coefficient matrices were used to explore the correlation between the covariables. Results. Basal ganglia ICH showed a higher possibility of absolute hematoma growth than thalamic ICH. The area under the curve (AUC) for absolute and relative growth of thalamic hemorrhage was lower than that of basal ganglia hemorrhage (AUC 0.71 and 0.67, respectively) in discriminating short-term poor outcome with an AUC of 0.59 and 0.60, respectively. Each threshold of HE independently predicted poor outcome in basal ganglia ICH ( P < 0.001 ), with HE > 3 ml and > 6 ml showing higher positive predictive values and accuracy compared to HE > 33 % . In contrast, thalamic ICH had a smaller baseline volume (BV, 9.55 ± 6.85 ml ) and was more likely to initially involve the posterior limb of internal capsule (PLIC) (85/153, 57.82%), and the risk of HE was lower without PLIC involvement (4.76%, P = 0.009 ). Therefore, in multivariate analysis, the effect of thalamic HE on poor prognosis was largely replaced by BV and the involvement of PLIC, and the adjusted odds ratios (ORs) of HE was not significant ( P > 0.05 ). Conclusion. Though HE is a high-risk factor for short-term poor functional outcome, it is not an independent risk factor in thalamic ICH, and absolute growth is more predictive of poor outcome than relative growth for basal ganglia ICH.

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Abstract TP325: Lack of Early Improvement Predicts Poor Clinical Outcome Following Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.tp325 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vignan Yogendrakumar ◽

Eric E Smith ◽

Andrew M Demchuk ◽

RIchard I Aviv ◽

David Rodriguez-Luna ◽

...

Keyword(s):

Clinical Outcome ◽

Area Under The Curve ◽

Roc Curves ◽

Predictive Values ◽

Early Improvement ◽

Poor Outcome ◽

Using Data ◽

Definition Of ◽

Sensitivity Specificity ◽

The Cost

Background: Early Neurological Worsening (ENW) is common after ICH, and predicts poor outcome. However, there is limited data as to what degree of ENW best relates to outcome. We used two ICH cohorts to refine and validate a definition of ENW that best predicted 90-day outcomes. Methods: We generated receiver operating characteristic (ROC) curves for the association between 24-hour NIHSS change and ICH outcomes using data from the VISTA collaboration. Primary outcome was poor outcome at 90 days (mRS 4-6); secondary outcomes were other mRS cutpoints (mRS 2-6, 3-6, 5-6, 6). We tested the commonly used NIHSS≥4 definition and in addition employed Youden’s J Index to select optimal cutpoints and calculated sensitivity, specificity, and predictive values. Independent predictors of poor outcome were determined via multivariable logistic regression. Definitions were validated in the prospectively collected PREDICT-ICH cohort. Results: Using 552 patients from the VISTA cohort, ROC curves of 24hr NIHSS change had an area under the curve of 0.75. NIHSS change of ≥0 at 24hrs was seen in 46.4%. Youden’s method showed an optimum cutoff at -0.5. Based on this, ENW defined as >0 (Sens 43%, Spec 91%, PPV 83%, aOR 7.13 [CI:4.05-12.55]), ≥0 (Sens 65%, Spec 73%, PPV 70%, aOR 5.05 [CI:3.25-7.85]), or ≥-1 (Sens 78%, Spec 59%, PPV 65%, aOR 6.04 [CI:3.75-9.71]) all accurately predicted poor outcome. PPV increased with higher NIHSS cutoffs, but at the cost of lower sensitivities. Regression confirmed that all definitions independently predicted outcome at all mRS cutpoints. ENW definitions reproduced well in the validation cohort of 275 patients. Conclusion: All NIHSS cut-offs for ENW predict clinical outcome, regardless of outcome definition. In particular, lack of clinical improvement at 24 hours (i.e. NIHSS is the same or higher) robustly predicted poor outcome, but may not be sufficiently reliable to determine clinical management.

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Abstract WMP83: Prediction of Intracerebral Hematoma Expansion: Multicenter External Validation of the CTA Spot Sign Score

Stroke ◽

10.1161/str.44.suppl_1.awmp83 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Thien J Huynh ◽

Andrew Demchuk ◽

Dar Dowlatshahi ◽

Ölem Krischek ◽

Alex Kiss ◽

...

Keyword(s):

External Validation ◽

Area Under The Curve ◽

Hematoma Expansion ◽

Intracerebral Hematoma ◽

Spot Sign ◽

Perfect Agreement ◽

Sagittal Sinus ◽

Spot Number ◽

Hematoma Growth ◽

Contrast Ct

Background and Purpose: The spot sign score (SSS) stratifies hematoma expansion risk in patients with acute intracerebral hemorrhage (ICH) but is not externally validated. We sought to validate the SSS and assess prognostic spot characteristics associated with hematoma expansion in a prospective multicenter study. Methods: We studied 228 ICH patients presenting < 6 hours post-onset enrolled in the PREDICT (PREdicting hematoma growth anD outcome in ICH using contrast bolus CT) study, a multicentre prospective observational cohort study of ICH patients evaluated with baseline non-contrast CT, CT angiography (CTA), and 24-hour follow-up CT. Primary outcome was significant hematoma expansion (>6ml or >33%). Secondary outcomes were absolute and relative expansion. Blinded CTA spot sign characterization (spot number, maximum axial size and attenuation, and relative attenuation compared to the ipsilateral internal carotid artery and superior sagittal sinus) and SSS calculation was performed independently by two neuroradiologists and a radiology resident. Multivariable regression for prediction of hematoma expansion was performed and diagnostic performance of the SSS and spot characteristics was examined with ROC analysis and tests for trend. Results: SSS independently predicted significant, absolute, and relative hematoma expansion (p-values of 0.001, <0.001, and 0.009, respectively), adjusting for initial hematoma volume, INR, mean arterial pressure, and time from onset-to-baseline CT, and demonstrated near perfect interobserver agreement (κ = 0.82). Spot number and SSS demonstrated similar area under the curve (AUC 0.69 vs. 0.68, p=0.149) for hematoma expansion. Incremental risk of hematoma expansion was demonstrated with increasing SSS however a significant trend was not identified (p trend=0.720). Of all spot characteristics, only spot number was independently associated with expansion (p<0.001) providing incremental risk stratification (p trend=0.050) and near perfect agreement (κ=0.85). Median absolute hematoma growth for 0, 1, 2 to 3, ≥4 spots was 0.4, 4, 12, 82 ml respectively. Conclusion: Spot number is the single best predictor of significant ICH expansion and appears to be as good as the total SSS in predicting expansion.

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Evaluation of intraventricular hemorrhage assessment methods for predicting outcome following intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/2011.9.jns10850 ◽

2012 ◽

Vol 116 (1) ◽

pp. 185-192 ◽

Cited By ~ 37

Author(s):

Brian Y. Hwang ◽

Samuel S. Bruce ◽

Geoffrey Appelboom ◽

Matthew A. Piazza ◽

Amanda M. Carpenter ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Receiver Operating Characteristic ◽

Intraventricular Hemorrhage ◽

Operating Characteristic ◽

Medical Center ◽

External Ventricular Drain ◽

Characteristic Analysis ◽

Poor Outcome ◽

The Impact ◽

Receiver Operating

Object Intraventricular hemorrhage (IVH) associated with intracerebral hemorrhage (ICH) is an independent predictor of poor outcome. Clinical methods for evaluating IVH, however, are not well established. This study sought to determine the best IVH grading scale by evaluating the predictive accuracies of IVH, Graeb, and LeRoux scores in an independent cohort of ICH patients with IVH. Subacute IVH dynamics as well as the impact of external ventricular drain (EVD) placement on IVH and outcome were also investigated. Methods A consecutive cohort of 142 primary ICH patients with IVH was admitted to Columbia University Medical Center between February 2009 and February 2011. Baseline demographics, clinical presentation, and hospital course were prospectively recorded. Admission CT scans performed within 24 hours of onset were reviewed for ICH location, hematoma volume, and presence of IVH. Intraventricular hemorrhage was categorized according to IVH, Graeb, and LeRoux scores. For each patient, the last scan performed within 6 days of ictus was similarly evaluated. Outcomes at discharge were assessed using the modified Rankin Scale (mRS). Receiver operating characteristic analysis was used to determine the predictive accuracies of the grading scales for poor outcome (mRS score ≥ 3). Results Seventy-three primary ICH patients (51%) had IVH. Median admission IVH, Graeb, and LeRoux scores were 13, 6, and 8, respectively. Median IVH, Graeb and LeRoux scores decreased to 9 (p = 0.005), 4 (p = 0.002), and 4 (p = 0.003), respectively, within 6 days of ictus. Poor outcome was noted in 55 patients (75%). Areas under the receiver operating characteristic curve were similar among the IVH, Graeb, and LeRoux scores (0.745, 0.743, and 0.744, respectively) and within 6 days postictus (0.765, 0.722, 0.723, respectively). Moreover, the IVH, Graeb, and LeRoux scores had similar maximum Youden Indices both at admission (0.515 vs 0.477 vs 0.440, respectively) and within 6 days postictus (0.515 vs 0.339 vs 0.365, respectively). Patients who received EVDs had higher mean IVH volumes (23 ± 26 ml vs 9 ± 11 ml, p = 0.003) and increased incidence of Glasgow Coma Scale scores < 8 (67% vs 38%, p = 0.015) and hydrocephalus (82% vs 50%, p = 0.004) at admission but had similar outcome as those who did not receive an EVD. Conclusions The IVH, Graeb, and LeRoux scores predict outcome well with similarly good accuracy in ICH patients with IVH when assessed at admission and within 6 days after hemorrhage. Therefore, any of one of the scores would be equally useful for assessing IVH severity and risk-stratifying ICH patients with regard to outcome. These results suggest that EVD placement may be beneficial for patients with severe IVH, who have particularly poor prognosis at admission, but a randomized clinical trial is needed to conclusively demonstrate its therapeutic value.

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New and expanding ventricular hemorrhage predicts poor outcome in acute intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000008007 ◽

2019 ◽

Vol 93 (9) ◽

pp. e879-e888 ◽

Cited By ~ 9

Author(s):

Vignan Yogendrakumar ◽

Tim Ramsay ◽

Dean Fergusson ◽

Andrew M. Demchuk ◽

Richard I. Aviv ◽

...

Keyword(s):

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Volume Change ◽

Massachusetts General Hospital ◽

Nonlinear Models ◽

Hematoma Expansion ◽

Term Outcome ◽

Long Term Outcome ◽

Poor Outcome ◽

Fractional Polynomial

ObjectiveTo describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations.MethodsWe used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4–6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital).ResultsOf the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four–hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11–6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22–5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients.ConclusionIVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.

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Revised intracerebral hemorrhage expansion definitions: Relationship with care limitations

International Journal of Stroke ◽

10.1177/1747493020967255 ◽

2020 ◽

pp. 174749302096725

Author(s):

Ronda Lun ◽

Vignan Yogendrakumar ◽

Greg Walker ◽

Michel Shamy ◽

Robert Fahed ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Intraventricular Hemorrhage ◽

Primary Outcome ◽

Secondary Analysis ◽

Hematoma Expansion ◽

Primary Analysis ◽

Predictive Values ◽

C Statistic ◽

Revised Definitions ◽

Sensitivity Specificity

Background Hematoma expansion is an important therapeutic target in intracerebral hemorrhage. Recently proposed hematoma expansion definitions have not been validated, and no previous definition has accounted for withdrawal of care. Aims To externally validate revised definitions of hematoma expansion that incorporate intraventricular hemorrhage, and to test their validity in the context of withdrawal of care. Methods We analyzed data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage II trial, comparing revised definitions of hematoma expansion incorporating intraventricular hemorrhage expansion to the conventional definition of “≥6 mL or ≥33%.” Primary outcome was modified Rankin Scale of 4–6 at 90 days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c-statistic for all definitions of hematoma expansion. Definitions were compared using nonparametric methods. Secondary analyses were performed after removing patients with withdrawal of care. Results Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any intraventricular hemorrhage,” with increased c-statistic from 60.2% to 65.9% ( p < 0.001). Secondary analysis excluded 46 participants who experienced withdrawal of care. The revised definitions similarly outperformed the conventional definition in this population, with the greatest improvement in c-statistic using “≥6 mL or ≥33% or any intraventricular hemorrhage” (58.1% vs. 64.1%, p < 0.001). Conclusions Revised hematoma expansion definitions incorporating intraventricular hemorrhage expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.

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Abstract TP348: Extraventricular Drain Placement is Associated With Improved Outcome After Intracerebral Hemorrhage With Intraventricular Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.tp348 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Andrew D Warren ◽

Qi Li ◽

Kristin Schwab ◽

Steven M Greenberg ◽

Anand Viswanathan ◽

...

Keyword(s):

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Intraventricular Hemorrhage ◽

Medical Center ◽

Obstructive Hydrocephalus ◽

Academic Medical Center ◽

Univariate Analysis ◽

Neurologic Outcome ◽

Lower Mortality ◽

Poor Outcome

Background and Aims: Many patients with intracerebral hemorrhage (ICH) develop intraventricular hemorrhage (IVH). External ventricular drains (EVDs) are commonly placed to treat obstructive hydrocephalus, but there is little data on how much patients benefit. We explored the use of EVD in ICH patients and any association with clinical outcome. Methods: We analyzed patients with primary ICH presenting to one academic medical center between 2000-2019. Patients with ICH secondary to trauma, aneurysm, and stroke were excluded. 3 month telephone interviews were used to assess clinical outcome. Good outcome was defined as 90 day modified Rankin score (mRS) of 0-3. Results: During this period 2,486 patients presented with primary ICH. Overall, patients were 73 (+/- 13) years old; 54% were male, 46% had IVH. Factors associated with IVH presence included ICH volume (29 cm 3 vs 9 cm 3 , p < 0.001), deep location (48% vs 37%, p < 0.001), and lower median Glasgow Coma Scale (GCS) score (9 vs 15, p < 0.001). IVH presence was associated with higher 90 day mortality (57% vs. 19%, p < 0.001) and poor outcome (86% vs 47%, p < 0.001). An EVD was placed in 29% of patients with IVH and 4% of those without. IVH patients with EVD were younger (67 +/- 13 vs 74 +/- 13, p < 0.001), had larger IVH volumes (17 cm 3 vs 8 cm 3 , p < 0.001), and had lower GCS scores (7 vs 10, p < 0.001) compared to other IVH patients. In univariate analysis, EVD placement was associated with poor outcome (88% vs 85%, p < 0.001) but lower 90 day mortality (53% vs 59%, p = 0.048). In multivariate analysis controlling for age, ICH and IVH volumes, and Comfort Measures Only (CMO) status, EVD placement was associated with lower 90 day mortality (OR 0.68, 95% CI 0.47 - 0.98, p = 0.041), and was associated with lower chance of poor outcome (OR 0.43, 95% CI 0.25 - 0.72, p = 0.002). However, when controlling for intubation, these associations were no longer seen with 90-day mortality (OR 1.07, 95% CI 0.72 - 1.60, p = 0.737) or with poor outcome (OR 0.68, 95% CI 0.38 - 1.23, p = 0.202). Conclusion: IVH is relatively common after ICH. In univariate analysis, EVD placement is associated with lower mortality but worse neurologic outcome. However, after controlling for potential confounding factors, EVD is associated with lower mortality and better neurologic outcome.

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Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

International Journal of Stroke ◽

10.1177/1747493020976247 ◽

2020 ◽

pp. 174749302097624

Author(s):

Mikel Terceño ◽

Yolanda Silva ◽

Saima Bashir ◽

Víctor A Vera-Monge ◽

Pere Cardona ◽

...

Keyword(s):

Clinical Outcome ◽

General Anesthesia ◽

Scale Score ◽

Conscious Sedation ◽

Posterior Circulation ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Poor Outcome ◽

The Impact

Background The impact of general anesthesia on functional outcome in patients with large vessel occlusion remains unclear. Most studies have focused on anterior circulation large vessel occlusion; however, little is known about the effect of general anesthesia in patients with posterior circulation—large vessel occlusion. Methods We performed a retrospective analysis from the prospective CICAT registry. All patients with posterior circulation—large vessel occlusion—and undergoing endovascular therapy between January 2016 and January 2020 were included. Demographics, baseline characteristics, procedural data, and anesthesia modality (general anesthesia or conscious sedation) were evaluated. The primary outcome was the proportion of patients with good clinical outcome (modified Rankin Scale score of 0–2) at three months. Results 298 patients underwent endovascular treatment with posterior circulation—large vessel occlusion—were included. Age, diabetes mellitus, renal insufficiency, baseline National Institutes of Health Stroke Scale score, puncture to recanalization length, ≥3 device passes, absent of successful recanalization (defined as treatment in cerebral ischemia of 3), and general anesthesia were statistically associated with poor outcome (mRS: 3-6). In the multivariable regression, general anesthesia and ≥3 device passes were independently associated with poor outcome (aOR: 3.11, (95% CI: 1.34–7.2); P = 0.01 and 3.77, (95% CI: 1.29–11.01); P = 0.02, respectively). Patients treated with general anesthesia were less likely to have a good outcome at three months compared to conscious sedation (19.7% vs. 45.1%, P < 0.001). Conclusions In our study population, general anesthesia use is associated with poor clinical outcome in patients with posterior circulation—large vessel occlusion—treated endovascularly.

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Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation

Thrombosis and Haemostasis ◽

10.1160/th14-02-0176 ◽

2014 ◽

Vol 112 (12) ◽

pp. 1312-1318 ◽

Cited By ~ 5

Author(s):

Tae-Jin Song ◽

Jinkwon Kim ◽

Hye Sun Lee ◽

Chung Mo Nam ◽

Hyo Seok Nam ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Mixed Model ◽

Linear Mixed Model ◽

Brain Infarction ◽

Stroke Severity ◽

Stroke Outcome ◽

Poor Outcome ◽

Acute Infarction ◽

The Impact

SummaryThere has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with nonvalvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.

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Higher Cerebral Blood Flow Predicts Early Hematoma Expansion in Patients With Intracerebral Hemorrhage: A Clinical Study

Frontiers in Neurology ◽

10.3389/fneur.2021.735771 ◽

2021 ◽

Vol 12 ◽

Author(s):

Weijing Wang ◽

Weitao Jin ◽

Hao Feng ◽

Guoliang Wu ◽

Wenjuan Wang ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Intracerebral Hemorrhage ◽

Cerebral Hemorrhage ◽

Early Stage ◽

Acute Stage ◽

Hematoma Expansion ◽

Hematoma Volume ◽

Hematoma Growth ◽

Contrast Ct

The early hematoma expansion of intracerebral hemorrhage (ICH) indicates a poor prognosis. This paper studies the relationship between cerebral blood flow (CBF) around the hematoma and hematoma expansion (HE) in the acute stage of intracerebral hemorrhage. A total of 50 patients with supratentorial cerebral hemorrhage were enrolled in this study. They underwent baseline whole-brain CTP within 6 h after intracerebral hemorrhage, and non-contrast CT within 24 h. Absolute hematoma growth and relative hematoma growth were calculated, respectively. A relative growth of Hematoma volume >33% was considered to be hematoma expansion. The Ipsilateral peri-edema CBF and Ipsilateral edema CBF were calculated by CTP maps in patients with and without hematoma expansion, respectively. In this study the incidence of hematoma expansion in the early stage of supratentorial cerebral hemorrhage was 32%; The CBF of the hematoma expansion group was higher than that of the patients without hematoma expansion (23.5 ± 12.5 vs. 15.1 ± 7.4, P = 0.004). After adjusting for age, gender, Symptom onset to NCCT and Baseline hematoma volume, ipsilateral peri-edema CBF was still an independent risk factor for early HE (or = 1.095, 95% CI = 1.01–1.19, P = 0.024). Here, we concluded that higher cerebral blood flow predicts early hematoma expansion in patients with intracerebral hemorrhage.

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