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Fainardi E, Busto G, Bernardoni A, Padovani A, Casetta I, Morotti A. Perihematomal oligemia is associated with progression to ischemia and poor outcome in a subset of patients with intracerebral hemorrhage. Eur Radiol 2025; 35:1255-1264. [PMID: 39630194 DOI: 10.1007/s00330-024-11243-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 10/09/2024] [Accepted: 10/31/2024] [Indexed: 02/20/2025]
Abstract
OBJECTIVES We aimed to characterize the longitudinal evolution of perihematomal oligemia in acute intracerebral hemorrhage (ICH). MATERIALS AND METHODS A single center prospectively collected cohort of 150 patients with primary spontaneous ICH were imaged with computed tomography perfusion within 6 h from onset (T0), at 24 h (T1) and at 7 days (T7). Perihematomal cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area and categorized into ischemic (< 20 mL/100 g/min), oligemic (20-39.9 mL/100 g/min), normal (40-55 mL/100 g/min) and hyperemic (> 55 mL/100 g/min). RESULTS pCBF values were ischemic in 20.7%, oligemic 47.3%, normal in 17.3%, and hyperemic in 14.7% of patients at T0. All patients with T0 ischemia remained ischemic at T7, normal and hyperemic patients at T0 maintained good perfusion values at T7, whereas 46.5% of oligemic patients at T0 developed delayed perihematomal ischemia. In patients with T0 perihematomal oligemia, the risk of conversion into delayed ischemia at T7 was higher in those with pCBF < 30 mL/100 g/min (p < 0.001). A total of 42.7% patients had perihematomal ischemia at T7 and this profile correlated with poor outcome, regardless of baseline perfusion status. CONCLUSION Our findings suggest that perihematomal oligemia may not represent a benign entity and indicate that delayed perihematomal ischemia is common and associated with unfavorable outcome. KEY POINTS Question The natural history and longitudinal evolution of perihematomal oligemia over time in patients with intracerebral hemorrhage (ICH) remains to be established. Findings Conversion of baseline perihematomal oligemia into ischemia occurs in 46.5% of oligemic ICH patients at 7 days, where a total of 42.7% patients were ischemic. Clinical relevance Evolution of perihematomal oligemia into ischemia during the transition from hyperacute to subacute phases is common. ICH patients with perihemorrhagic cerebral blood flow values < 30 mL/100 g/min are at high risk of ischemic progression, which in turn contributes to poor outcome.
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Affiliation(s)
- Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Florence, Italy.
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Florence, Italy
| | - Andrea Bernardoni
- Neuroradiology Unit, Department of Radiology, Arcispedale S. Anna, Ferrara, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Andrea Morotti
- Department of Neurological and Vision Sciences, Neurology Unit, ASST Spedali Civili, Brescia, Italy
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Xia X, Liu J, Cui J, You Y, Huang C, Li H, Zhang D, Ren Q, Jiang Q, Meng X. A nomogram incorporating CT-based peri-hematoma radiomics features to predict functional outcome in patients with intracerebral hemorrhage. Eur J Radiol 2025; 183:111871. [PMID: 39662425 DOI: 10.1016/j.ejrad.2024.111871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/22/2024] [Accepted: 12/02/2024] [Indexed: 12/13/2024]
Abstract
OBJECTIVE To evaluate the ability of non-contrast computed tomography based peri-hematoma and intra-hematoma radiomic features to predict the 90-day poor functional outcome for spontaneous intracerebral hemorrhage (sICH) and to present an effective clinically relevant machine learning system to assist in prognosis prediction. MATERIALS AND METHODS We retrospectively analyzed the data of 691 patients diagnosed with sICH at two medical centers. Fifteen radiomic features from the intra- and peri-hematoma regions were extracted and selected to build six radiomics models. The clinical-semantic model and nomogram model were constructed to compare prediction abilities. The areas under the curve (AUC) and decision curve analysis were used to evaluate discriminative performance. RESULTS Combining radiomics of the intra-hematoma with peri-hematoma regions significantly improved the AUC to 0.843 compared with radiomics of the intra-hematoma region (AUC = 0.780, P < 0.001) in the test set. A similar trend was observed in the external validation cohort (AUC, 0.769 vs. 0.793, P = 0.709). The nomogram, which integrates clinical-semantic signatures with intra-hematoma and peri-hematoma radiomics signatures, accurately predicted a 90-day poor functional outcome in both the test and external validation sets (AUC 0.879 and 0.901, respectively). CONCLUSION The nomogram constructed using clinical-semantic signatures and combined intra-hematoma and peri-hematoma radiomics signatures showed the potential to precisely predict 90-day poor functional outcomes for sICH.
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Affiliation(s)
- Xiaona Xia
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Jieqiong Liu
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi You
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing 100080, China
| | - Hui Li
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Daiyong Zhang
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Qingguo Ren
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Qingjun Jiang
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China
| | - Xiangshui Meng
- Department of Radiology, Qilu Hospital (Qingdao) of Shandong University, Qingdao, China.
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Chen Y, Guo H, Sun X, Wang S, Zhao M, Gong J, He A, Li J, Liu Y, Wang Z. Melatonin Regulates Glymphatic Function to Affect Cognitive Deficits, Behavioral Issues, and Blood-Brain Barrier Damage in Mice After Intracerebral Hemorrhage: Potential Links to Circadian Rhythms. CNS Neurosci Ther 2025; 31:e70289. [PMID: 39981743 PMCID: PMC11843476 DOI: 10.1111/cns.70289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 01/13/2025] [Accepted: 02/06/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a life-threatening cerebrovascular disorder with no specific pharmacological treatment. ICH causes significant behavioral deficits and cognitive impairments. Recent research suggests that circadian rhythm regulation could be a promising therapeutic strategy for ICH. Melatonin has been shown to alleviate glymphatic system (GS) dysfunction by regulating circadian rhythms, thereby improving depressive-like behaviors and postoperative sleep disorders in mice. However, its application in ICH treatment and specific mechanisms are not well understood. METHODS ICH models were created in 8-to-10-week-old mice using collagenase injection. Circadian rhythm modulation was tested with melatonin and luzindole. Behavioral and cognitive impairments were assessed with the modified neurological severity score, corner test, and novel object recognition test. Brain water content was measured by the dry/wet weight method, and cerebral perfusion was assessed by cerebral blood flow measurements. GS function was evaluated using RITC-dextran and Evans blue assays. Immunofluorescence and western blotting were used to analyze GS function and BBB permeability. RESULTS Melatonin restored GS transport after ICH, promoting hematoma and edema absorption, reducing BBB damage, and improving cognitive and behavioral outcomes. However, luzindole partially blocked these benefits and reversed the neuroprotective effects. CONCLUSION Melatonin and luzindole treatment affect GS function, BBB permeability, and cognitive-behavioral outcomes in mice with ICH. The underlying mechanism may involve the regulation of circadian rhythms.
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Affiliation(s)
- Yunzhao Chen
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
- Department of NeurosurgeryInner Mongolia Autonomous Region People's HospitalHohhotChina
| | - Hexi Guo
- Department of NeurosurgeryOrdos Central HospitalOrdosChina
| | - Xinguo Sun
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
- Department of NeurosurgeryBinzhou People's HospitalBinzhouChina
| | - Shanjun Wang
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
- Department of NeurosurgeryYidu Central Hospital of WeifangQingzhouChina
| | - Mingyu Zhao
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
| | - Junjie Gong
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
| | - Anqi He
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
| | - Jing Li
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
| | - Yuheng Liu
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
| | - Zengguang Wang
- Department of Neurosurgery, Tianjin Neurological InstituteTianjin Medical University General HospitalTianjinChina
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Yang L, Wang MH, Song J, Bao YF, Yuan Q, Wang Y, Hu J, Yu J, Wu G, Zhao JL. Intracranial Pressure Variability Associates with 3-Month Outcomes in Spontaneous Intracerebral Hemorrhage: A Retrospective Analysis of 597 Patients. World Neurosurg 2024:S1878-8750(24)01537-7. [PMID: 39243970 DOI: 10.1016/j.wneu.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/01/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke, and most favorable treatments to improve patients' neurologic outcomes are not clear. Invasive intracranial pressure (ICP) monitoring is a common treatment of ICH, but whether patients with ICH could benefit from ICP monitoring is controversial. ICP variability (IPV) has been shown to correlate with poor outcomes in patients with subarachnoid hemorrhage and traumatic brain injury, but this association has not been clearly elucidated in patients with ICH. We hypothesized that 72-hour IPV from time of ICP probe implantation is associated with outcomes in patients with ICH. METHODS A retrospective chart review analysis of adult patients with ICH who received ICP monitoring at Huashan Hospital, Fudan University between January 2008 and January 2023 was performed. We included patients with ICH within 6 hours of signs or symptoms onset. Outcomes of patients with ICH were assessed using 3-month modified Rankin Scale (mRS) score, and were dichotomized into a poor (mRS score 4-6) and good (mRS score 0-3) outcome group. ICPs were recorded from the implantation of invasive ICP probe until it was removed. ICP was analyzed in the acute period, from 0 to 72 hours after ICP implantation. IPV was analyzed by SD, coefficient of variation, and successive variation of ICP. RESULTS We analyzed 597 patients' charts. The first mean ICP assessment, immediately after ICP implantation, at a median 117 minutes (interquartile range, 82-231 minutes) after admission was 20.5 (SD 7.8) mm Hg. The second mean ICP assessment, on neurosurgical intensive care unit arrival after operation, was 14.6 (SD 8.3) mm Hg. Poor outcomes occurred in 213 patients (35.68%). In univariate analysis, univariate quintile analysis, or multivariate analysis, ICP SD, ICP coefficient of variation, and ICP successive variation were associated with poor outcomes. CONCLUSIONS IPV during the first 72 hours after ICP implantation in patients with ICH was independently associated with poor functional outcome at 3 months. Stabilization of IPV during hyperacute and acute periods may be a potential therapeutic target to improve functional outcomes of these patients.
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Affiliation(s)
- Lei Yang
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurosurgery & Neurocritical Care, Huashan Hospital Fudan University, Shanghai, China
| | - Mei-Hua Wang
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurosurgery & Neurocritical Care, Huashan Hospital Fudan University, Shanghai, China
| | - Jie Song
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurosurgery & Neurocritical Care, Huashan Hospital Fudan University, Shanghai, China
| | - Yi-Feng Bao
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Yuan
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Wang
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin Hu
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurosurgery & Neurocritical Care, Huashan Hospital Fudan University, Shanghai, China
| | - Jian Yu
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Wu
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Lan Zhao
- Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, Shanghai, China.
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5
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Song X, Zhang H, Han Y, Lou S, Zhao E, Dong Y, Yang C. Based on hematoma and perihematomal tissue NCCT imaging radiomics predicts early clinical outcome of conservatively treated spontaneous cerebral hemorrhage. Sci Rep 2024; 14:18546. [PMID: 39122887 PMCID: PMC11315882 DOI: 10.1038/s41598-024-69249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a very serious kind of stroke. If the outcome of patients can be accurately assessed at the early stage of disease occurrence, it will be of great significance to the patients and clinical treatment. The present study was conducted to investigate whether non-contrast computer tomography (NCCT) models of hematoma and perihematomal tissues could improve the accuracy of short-term prognosis prediction in ICH patients with conservative treatment. In this retrospective analysis, a total of 166 ICH patients with conservative treatment during hospitalization were included. Patients were randomized into a training group (N = 132) and a validation group (N = 34) in a ratio of 8:2, and the functional outcome at 90 days after clinical treatment was assessed by the modified Rankin Scale (mRS). Radiomic features of hematoma and perihematomal tissues of 5 mm, 10 mm, 15 mm were extracted from NCCT images. Clinical factors were analyzed by univariate and multivariate logistic regression to identify independent predictive factors. In the validation group, the mean area under the ROC curve (AUC) of the hematoma was 0.830, the AUC of the perihematomal tissue within 5 mm, 10 mm, 15 mm was 0.792, 0.826, 0.774, respectively, and the AUC of the combined model of hematoma and perihematomal tissue within 10 mm was 0.795. The clinical-radiomics nomogram consisting of five independent predictors and radiomics score (Rad-score) of the hematoma model were used to assess 90-day functional outcome in ICH patients with conservative treatment. Our findings found that the hematoma model had better discriminative efficacy in evaluating the early prognosis of conservatively managed ICH patients. The visual clinical-radiomics nomogram provided a more intuitive individualized risk assessment for 90-day functional outcome in ICH patients with conservative treatment. The hematoma could remain the primary therapeutic target for conservatively managed ICH patients, emphasizing the need for future clinical focus on the biological significance of the hematoma itself.
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Affiliation(s)
- Xuelin Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Hao Zhang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuxuan Han
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Shiyun Lou
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Endong Zhao
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Yang Dong
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, 116023, China
| | - Chao Yang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China.
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Smith CJ, Rossitto CP, Manhart M, Fuhrmann I, DiNitto J, Baker T, Ali M, Sarmiento M, Mocco J, Kellner CP. Minimally Invasive Intracerebral Hemorrhage Evacuation Improves Pericavity Cerebral Blood Volume. Transl Stroke Res 2024; 15:599-605. [PMID: 37195548 DOI: 10.1007/s12975-023-01155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Cerebral blood volume mapping can characterize hemodynamic changes within brain tissue, particularly after stroke. This study aims to quantify blood volume changes in the perihematomal parenchyma and pericavity parenchyma after minimally invasive intracerebral hemorrhage evacuation (MIS for ICH). Thirty-two patients underwent MIS for ICH with pre- and post-operative CT imaging and intraoperative perfusion imaging (DynaCT PBV Neuro, Artis Q, Siemens). The pre-operative and post-operative CT scans were segmented using ITK-SNAP software to calculate hematoma volumes and to delineate the pericavity tissue. Helical CT segmentations were registered to cone beam CT data using elastix software. Mean blood volumes were computed inside subvolumes by dilating the segmentations at increasing distances from the lesion. Pre-operative perihematomal blood volumes and post-operative pericavity blood volumes (PBV) were compared. In 27 patients with complete imaging, post-operative PBV significantly increased within the 6-mm pericavity region after MIS for ICH. The mean relative PBV increased by 21.6 and 9.1% at 3 mm and 6 mm, respectively (P = 0.001 and 0.016, respectively). At the 9-mm pericavity region, there was a 2.83% increase in mean relative PBV, though no longer statistically significant. PBV analysis demonstrated a significant increase in pericavity cerebral blood volume after minimally invasive ICH evacuation to a distance of 6 mm from the border of the lesion.
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Affiliation(s)
- Colton J Smith
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | | | | | - Turner Baker
- Sinai BioDesign, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Ma K, Bebawy JF. Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature. Anesth Analg 2024; 138:992-1002. [PMID: 38109853 DOI: 10.1213/ane.0000000000006772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Anemia is a highly prevalent condition that may compromise oxygen delivery to vital organs, especially among the critically ill. Although current evidence supports the adoption of a restrictive transfusion strategy and threshold among the nonbleeding critically ill patient, it remains unclear whether this practice should apply to the brain-injured patient, given the predisposition to cerebral ischemia in this patient population, in which even nonprofound anemia may exert a detrimental effect on clinical outcomes. The purpose of this review is to provide an overview of the pathophysiological changes related to impaired cerebral oxygenation in the brain-injured patient and to present the available evidence on the effect of anemia and varying transfusion thresholds on the clinical outcomes of patients with acute brain injury.
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Affiliation(s)
- Kan Ma
- From the Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F Bebawy
- Department of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abou Karam G, Tharmaseelan H, Aboian MS, Malhotra A, Gilmore EJ, Falcone GJ, de Havenon A, Sheth KN, Payabvash S. Clinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging - A pilot study. J Stroke Cerebrovasc Dis 2023; 32:107375. [PMID: 37738914 PMCID: PMC10591892 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Perihematomal edema (PHE) represents the secondary brain injury after intracerebral hemorrhage (ICH). However, neurobiological characteristics of post-ICH parenchymal injury other than PHE volume have not been fully characterized. Using intravoxel incoherent motion imaging (IVIM), we explored the clinical correlates of PHE diffusion and (micro)perfusion metrics in subacute ICH. MATERIALS AND METHODS In 41 consecutive patients scanned 1-to-7 days after supratentorial ICH, we determined the mean diffusion (D), pseudo-diffusion (D*), and perfusion fraction (F) within manually segmented PHE. Using univariable and multivariable statistics, we evaluated the relationship of these IVIM metrics with 3-month outcome based on the modified Rankin Scale (mRS). RESULTS In our cohort, the average (± standard deviation) age of patients was 68.6±15.6 years, median (interquartile) baseline National Institute of Health Stroke Scale (NIHSS) was 7 (3-13), 11 (27 %) patients had poor outcomes (mRS>3), and 4 (10 %) deceased during the follow-up period. In univariable analyses, admission NIHSS (p < 0.001), ICH volume (p = 0.019), ICH+PHE volume (p = 0.016), and average F of the PHE (p = 0.005) had significant correlation with 3-month mRS. In multivariable model, the admission NIHSS (p = 0.006) and average F perfusion fraction of the PHE (p = 0.003) were predictors of 3-month mRS. CONCLUSION The IVIM perfusion fraction (F) maps represent the blood flow within microvasculature. Our pilot study shows that higher PHE microperfusion in subacute ICH is associated with worse outcomes. Once validated in larger cohorts, IVIM metrics may provide insight into neurobiology of post-ICH secondary brain injury and identify at-risk patients who may benefit from neuroprotective therapy.
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Affiliation(s)
- Gaby Abou Karam
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine. 333 Cedar St, New Haven, CT 06510, USA
| | - Hishan Tharmaseelan
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine. 333 Cedar St, New Haven, CT 06510, USA
| | - Mariam S Aboian
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine. 333 Cedar St, New Haven, CT 06510, USA
| | - Ajay Malhotra
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine. 333 Cedar St, New Haven, CT 06510, USA
| | - Emily J Gilmore
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Adam de Havenon
- Center for Brain and Mind Health, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Division of Vascular Neurology, Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Seyedmehdi Payabvash
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine. 333 Cedar St, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA.
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9
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Fainardi E, Busto G, Scola E, Casetta I, Mizutani K, Consoli A, Boulouis G, Padovani A, Morotti A. Perfusion gradients promote delayed perihaematomal oedema in intracerebral haemorrhage. Brain Commun 2023; 5:fcad133. [PMID: 37151226 PMCID: PMC10162681 DOI: 10.1093/braincomms/fcad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/23/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
Perihaematomal oedema is a potential therapeutic target to improve outcome of patients with intracerebral haemorrhage, but its pathophysiology remains poorly elucidated. We investigated the longitudinal changes of cerebral perfusion and their influence on perihaematomal oedema development in 150 patients with intracerebral haemorrhage who underwent computed tomography perfusion within 6 h from onset, at 24 h and at 7 days. Perfusion parameters were measured in haemorrhagic core, perihaematomal rim, surrounding normal appearing and contralateral brain tissue. Computed tomography perfusion parameters gradually improved from the core to the periphery in each time interval with an early increase at 24 h followed by a delayed decline at 7 days compared with admission values (P < 0.001). Multivariable linear regression analysis showed that haematoma volume and cerebral blood flow gradient between normal appearing and perihaematomal rim were independently associated with absolute perihaematomal oedema volume in the different time points (within 6 h, B = 0.128, P = 0.032; at 24 h, B = 0.133, P = 0.016; at 7 days, B = 0.218, P < 0.001). In a secondary analysis with relative perihaematomal oedema as the outcome of interest, cerebral blood flow gradient between normal appearing and perihaematomal rim was an independent predictor of perihaematomal oedema only at 7 days (B = 0.239, P = 0.002). Our findings raise the intriguing hypothesis that perfusion gradients promote perihaematomal oedema development in the subacute phase after intracerebral haemorrhage.
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Affiliation(s)
- Enrico Fainardi
- Correspondence to: Enrico Fainardi, MD, PhD Struttura Organizzativa Dipartimentale di Neuroradiologia Dipartimento di Scienze Biomediche, Sperimentali e Cliniche ‘Mario Serio’ Università degli Studi di Firenze Ospedale Universitario Careggi Largo Brambilla 3, Firenze 50134, Italy E-mail:
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence 50139, Italy
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence 50139, Italy
| | - Ilaria Casetta
- Section of Neurological, Psychiatric and Psychological Sciences, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara 44121, Italy
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Arturo Consoli
- Department of Interventional and Diagnostic Neuroradiology, Hopitâl Foch, Suresnes, le de France, Paris 92150, France
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Centre Val de Loire Region, Tours 37020, France
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia 25121, Italy
- Department of Neurological Sciences and Vision, Neurology Unit, ASST Spedali Civili, Brescia 25123, Italy
| | - Andrea Morotti
- Department of Neurological Sciences and Vision, Neurology Unit, ASST Spedali Civili, Brescia 25123, Italy
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10
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Morotti A, Busto G, Boulouis G, Scola E, Padovani A, Casetta I, Fainardi E. Added value of non-contrast CT and CT perfusion markers for prediction of intracerebral hemorrhage expansion and outcome. Eur Radiol 2023; 33:690-698. [PMID: 35895123 DOI: 10.1007/s00330-022-08987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To test the hypothesis that the combined analysis of non-contrast CT (NCCT) and CT perfusion (CTP) imaging markers improves prediction of hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH). METHODS Retrospective, single-center analysis of patients with primary ICH undergoing NCCT and CTP within 6 h from onset. NCCT images were assessed for the presence of intrahematomal hypodensity and shape irregularity. Perihematomal cerebral blood volume and spot sign were assessed on CTP. The main outcomes of the analysis were HE (growth > 6 mL and/or > 33%) and poor functional prognosis (90 days modified Rankin Scale 3-6). Predictors of HE and outcome were explored with logistic regression. RESULTS A total of 150 subjects were included (median age 68, 47.1% males) of whom 54 (36%) had HE and 52 (34.7%) had poor outcome. The number of imaging markers on baseline imaging was independently associated with HE (odds ratio 2.66, 95% confidence interval 1.70-4.17, p < 0.001) and outcome (odds ratio 1.64, 95% CI 1.06-2.56, p = 0.027). Patients with the simultaneous presence of all the four markers had the highest risk of HE and unfavorable prognosis (mean predicted probability of 91% and 79% respectively). The combined-markers analysis outperformed the sensitivity of the single markers analyzed separately. In particular, the presence of at least one marker identified patients with HE and poor outcome with 91% and 87% sensitivity respectively. CONCLUSION NCCT and CTP markers provide additional yield in the prediction of HE and ICH outcome. KEY POINTS • Perihematomal hypoperfusion is associated with hematoma expansion and poor outcome in acute intracerebral hemorrhage. • Non-contrast CT and CT perfusion markers improve prediction of hematoma expansion and unfavorable prognosis. • A multimodal CT protocol including CT perfusion will help the identification of patients at high risk of clinical deterioration and poor outcome.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, P.le Spedali Civili 1, 25100, Brescia, Italy.
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Tours, Centre Val de Loire Region, France
| | - Elisa Scola
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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11
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Yang J, Jing J, Chen S, Liu X, Tang Y, Pan C, Tang Z. Changes in Cerebral Blood Flow and Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage. Transl Stroke Res 2022; 13:686-706. [PMID: 35305264 DOI: 10.1007/s12975-022-00998-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common subtype of stroke and places a great burden on the family and society with a high mortality and disability rate and a poor prognosis. Many findings from imaging and pathologic studies have suggested that cerebral ischemic lesions visualized on diffusion-weighted imaging (DWI) in patients with ICH are not rare and are generally considered to be associated with poor outcome, increased risk of recurrent (ischemic and hemorrhagic) stroke, cognitive impairment, and death. In this review, we describe the changes in cerebral blood flow (CBF) and DWI lesions after ICH and discuss the risk factors and possible mechanisms related to the occurrence of DWI lesions, such as cerebral microangiopathy, cerebral atherosclerosis, aggressive early blood pressure lowering, hyperglycemia, and inflammatory response. We also point out that a better understanding of cerebral DWI lesions will be a key step toward potential therapeutic interventions to improve long-term recovery for patients with ICH.
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Affiliation(s)
- Jingfei Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Jie Jing
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Xia Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
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12
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Lusk JB, Troy J, Nowacki N, Kranz PG, Maughan M, Laskowitz DT, James ML. An exploratory analysis of biomarkers of perihematomal edema in the CN-105 in participants with acute supratentorial intracerebral hemorrhage (CATCH) trial. J Stroke Cerebrovasc Dis 2022; 31:106600. [PMID: 35728356 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify biomarkers with potential to indicate severity of perihematomal edema and secondary tissue injury after intracerebral hemorrhage (ICH), and which could be used as surrogate markers in future clinical trials for novel ICH therapeutics. MATERIALS AND METHODS This exploratory cohort study compared trends in neuroinflammatory biomarker levels in 18 consecutively enrolled patients with acute supratentorial ICH and 16 patients treated with the investigational neuroprotective therapy CN-105 to identify a panel of 10 biomarkers. Biomarker levels over five days post-hemorrhage were then compared with edema volumes in a larger sample of patients treated with CN-105. RESULTS Mean normalized edema volumes increased over time; higher CRP levels were associated with increased edema volumes (p = 0.006, r = 0.56). Higher IL8, IL10, MCP, and MMP-9 levels were associated with decreased edema volumes (p = 0.005, r =-0.57; p = 0.02, r =-0.51; p = 0.02, r =-0.52; p = .002, r =-0.63, respectively). IL1-RA, IL1-B, IL23, vWF, and IL17 levels were not significantly associated with edema volumes (p > 0.05). CONCLUSIONS This exploratory study provides some of the first insights into the longitudinal associations between markers of neuroinflammation and development of perihematomal edema and secondary tissue injury in human ICH. We hypothesize that these biomarkers could be used as surrogates for treatment effect in novel therapies intended to limit neuroinflammation after ICH.
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Affiliation(s)
- Jay B Lusk
- Duke University School of Medicine and Fuqua School of Business, DUMC - 3094, Durham, NC 27710, United States.
| | - Jesse Troy
- Duke University Department of Biostatistics and Bioinformatics, United States
| | | | - Peter G Kranz
- Duke University Department of Radiology, United States
| | | | - Daniel T Laskowitz
- Duke University Departments of Anesthesiology and Neurology, Duke Clinical Research Institute and Aegis CN LLC, United States
| | - Michael L James
- Duke University Departments of Anesthesiology and Neurology and Duke Clinical Research Institute, United States
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13
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Machine Learning-Based Perihematomal Tissue Features to Predict Clinical Outcome after Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2022; 31:106475. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/02/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
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14
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Cheng Z, Zhang W, Zhan Z, Xia L, Han Z. Cerebral Small Vessel Disease and Prognosis in Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Cohort Studies. Eur J Neurol 2022; 29:2511-2525. [PMID: 35435301 DOI: 10.1111/ene.15363] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate whether cerebral small vessel disease (CSVD) markers and the total CSVD burden are associated with functional outcome, mortality, stroke recurrence, and hematoma expansion in patients with spontaneous intracerebral hemorrhage (ICH). METHODS Following a previously registered protocol (PROSPERO protocol: CRD42021287743), we systematically searched PubMed, Web of Science, and EMBASE to identify relevant literature up to November 2021. Cohort studies that examined the association between CSVD markers (white matter hyperintensity [WMH], lacune, enlarged perivascular space [EPVS], cerebral microbleed [CMB], and brain atrophy) or CSVD burden and prognosis in patients with ICH were included. The pooled estimates were calculated using random effects models. RESULTS Forty-one studies with 19,752 ICH patients were pooled in the meta-analysis. WMH (OR=1.50, 95% CI=1.32 to 1.70), lacune (OR=1.32, 95% CI=1.18 to 1.49), CMB (OR=2.60, 95% CI=1.13 to 5.97) and brain atrophy (OR=2.22, 95% CI=1.48 to 3.31) were associated with worse functional outcome. CSVD markers concerning increased risk of mortality were WMH (OR=1.57, 95% CI=1.38 to 1.79) and brain atrophy (OR=1.84, 95% CI=1.11 to 3.04), while concerning increased risk of stroke recurrence were WMH (OR=1.62, 95% CI=1.28 to 2.04) and lacune (OR=3.00, 95% CI=1.68 to 5.37). EPVS was not related to prognosis. There was a lack of association between CSVD markers and hematoma expansion. CSVD burden increased the risk of worse functional outcome, mortality, and stroke recurrence by 57%, 150%, and 44%, respectively. CONCLUSIONS In patients with spontaneous ICH, WMH, lacune, CMB, brain atrophy, and the total CSVD burden are associated with substantially increased risk of worse functional outcome, mortality, or stroke recurrence.
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Affiliation(s)
- Zicheng Cheng
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wenyuan Zhang
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China
| | - Zhenxiang Zhan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingfan Xia
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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15
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Morotti A, Busto G, Boulouis G, Scola E, Bernardoni A, Fiorenza A, Amadori T, Carbone F, Casetta I, Montecucco F, Fainardi E. Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage. Eur J Clin Invest 2022; 52:e13696. [PMID: 34706061 DOI: 10.1111/eci.13696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). METHODS A single-centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. RESULTS A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change -7.8 vs. -6.0 ml/100 g/min, p < .001, and median CBV change -0.5 vs. -0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15-1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18-2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08-5-54, p = .032). CONCLUSION Perihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Centre Val de Loire Region, France
| | - Elisa Scola
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Bernardoni
- Neuroradiology Unit, Department of Radiology, Arcispedale S. Anna, Ferrara, Italy
| | - Alessandro Fiorenza
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Amadori
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Federico Carbone
- First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabrizio Montecucco
- First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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16
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Lusk JB, Quinones QJ, Staats JS, Weinhold KJ, Grossi PM, Nimjee SM, Laskowitz DT, James ML. Coupling hematoma evacuation with immune profiling for analysis of neuroinflammation after primary intracerebral hemorrhage: a pilot study. World Neurosurg 2022; 161:162-168. [PMID: 35217228 DOI: 10.1016/j.wneu.2022.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the use and feasibility of an integrated hematoma evacuation/tissue preservation system coupled with immune profiling to assess human ex vivo immune cell populations from brain hematoma samples after intracerebral hemorrhage (ICH) METHODS: In this non-randomized, non-controlled pilot/feasibility study of 7 patients with primary supratentorial ICH, a hematoma evacuation device and integrated tissue preservation system were utilized to obtain hematoma samples during surgical evacuation. Samples were processed, cryopreserved, and analyzed using flow cytometry to determine the relative distribution of immune cell populations compared to peripheral blood mononuclear cells from healthy control subjects RESULTS: This study demonstrates proof of concept for an integrated hematoma evacuation and sample preservation system to collect human brain hematoma samples for flow cytometry analysis after acute human ICH. Hematoma samples in our preliminary analysis demonstrated different makeup of white blood cells than peripheral blood from healthy controls. CONCLUSIONS Flow cytometry analysis of hematoma samples in ICH demonstrates the potential to provide important insights into neuroinflammation associated with ICH.
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Affiliation(s)
- Jay B Lusk
- School of Medicine, Duke University, Durham, NC; Fuqua School of Business, Duke University, Durham, NC.
| | | | - Janet S Staats
- Duke Immune Profiling Core, Department of Surgery, Duke University, Durham, NC
| | - Kent J Weinhold
- Duke Immune Profiling Core, Department of Surgery, Duke University, Durham, NC
| | | | - Shahid M Nimjee
- Department of Neurological Surgery, The Ohio State University, Columbus, OH
| | - Daniel T Laskowitz
- Department of Anesthesiology, Duke University, Durham NC; Department of Neurology, Duke University, Durham NC
| | - Michael L James
- Department of Anesthesiology, Duke University, Durham NC; Department of Neurology, Duke University, Durham NC
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17
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Prognostic Significance of the Combined Score of Plasma Fibrinogen and Neutrophil-Lymphocyte Ratio in Patients with Spontaneous Intracerebral Hemorrhage. DISEASE MARKERS 2022; 2021:7055101. [PMID: 35003392 PMCID: PMC8731292 DOI: 10.1155/2021/7055101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023]
Abstract
Background The combination of plasma fibrinogen and neutrophil to lymphocyte ratio (F-NLR) score is a novel inflammatory marker constituted by peripheral blood fibrinogen concentration and neutrophil to lymphocyte ratio. In the current study, we aim to explore the relationship between admission F-NLR score and intracerebral hemorrhage (ICH) and assess its prognostic predictive ability in ICH patients. Methods The original cohort was consecutively recruited from August 2014 to September 2017, and the validation cohort was consecutively recruited between October 2018 and March 2020. The primary outcomes were 3-month functional outcome and 1-month mortality. All statistical analyses were performed using SPSS and R software. Results A total of 431 and 251 ICH patients were included in original cohort and validation cohort, respectively. In the original cohort, F-NLR score could independently predict the 3-month functional outcome (adjusted OR 2.013, 95% CI 1.316-3.078, p = 0.001) and 1-month mortality (adjusted OR 3.036, 95% CI 1.965-4.693, p < 0.001). Receiver operation characteristic (ROC) analyses and predictive model comparison indicated that F-NLR score had a stronger predictive ability in the 3-month outcome and 1-month mortality. Validation cohort verified the results. Conclusion F-NLR score was an independent indicator for both the 3-month functional outcome and 1-month mortality, and its prognostic predictive ability was superior to fibrinogen and NLR in both the original and the validation cohort.
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18
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Zhou W, Kholiqov O, Zhu J, Zhao M, Zimmermann LL, Martin RM, Lyeth BG, Srinivasan VJ. Functional interferometric diffusing wave spectroscopy of the human brain. SCIENCE ADVANCES 2021; 7:eabe0150. [PMID: 33980479 PMCID: PMC8115931 DOI: 10.1126/sciadv.abe0150] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 03/23/2021] [Indexed: 05/18/2023]
Abstract
Cerebral blood flow (CBF) is essential for brain function, and CBF-related signals can inform us about brain activity. Yet currently, high-end medical instrumentation is needed to perform a CBF measurement in adult humans. Here, we describe functional interferometric diffusing wave spectroscopy (fiDWS), which introduces and collects near-infrared light via the scalp, using inexpensive detector arrays to rapidly monitor coherent light fluctuations that encode brain blood flow index (BFI), a surrogate for CBF. Compared to other functional optical approaches, fiDWS measures BFI faster and deeper while also providing continuous wave absorption signals. Achieving clear pulsatile BFI waveforms at source-collector separations of 3.5 cm, we confirm that optical BFI, not absorption, shows a graded hypercapnic response consistent with human cerebrovascular physiology, and that BFI has a better contrast-to-noise ratio than absorption during brain activation. By providing high-throughput measurements of optical BFI at low cost, fiDWS will expand access to CBF.
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Affiliation(s)
- Wenjun Zhou
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Oybek Kholiqov
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Jun Zhu
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Mingjun Zhao
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Lara L Zimmermann
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Ryan M Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Bruce G Lyeth
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Vivek J Srinivasan
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA.
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Tech4Health Institute, NYU Langone Health, New York, NY, USA
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19
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Pszczolkowski S, Manzano-Patrón JP, Law ZK, Krishnan K, Ali A, Bath PM, Sprigg N, Dineen RA. Quantitative CT radiomics-based models for prediction of haematoma expansion and poor functional outcome in primary intracerebral haemorrhage. Eur Radiol 2021; 31:7945-7959. [PMID: 33860831 PMCID: PMC8452575 DOI: 10.1007/s00330-021-07826-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/19/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To test radiomics-based features extracted from noncontrast CT of patients with spontaneous intracerebral haemorrhage for prediction of haematoma expansion and poor functional outcome and compare them with radiological signs and clinical factors. MATERIALS AND METHODS Seven hundred fifty-four radiomics-based features were extracted from 1732 scans derived from the TICH-2 multicentre clinical trial. Features were harmonised and a correlation-based feature selection was applied. Different elastic-net parameterisations were tested to assess the predictive performance of the selected radiomics-based features using grid optimisation. For comparison, the same procedure was run using radiological signs and clinical factors separately. Models trained with radiomics-based features combined with radiological signs or clinical factors were tested. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) score. RESULTS The optimal radiomics-based model showed an AUC of 0.693 for haematoma expansion and an AUC of 0.783 for poor functional outcome. Models with radiological signs alone yielded substantial reductions in sensitivity. Combining radiomics-based features and radiological signs did not provide any improvement over radiomics-based features alone. Models with clinical factors had similar performance compared to using radiomics-based features, albeit with low sensitivity for haematoma expansion. Performance of radiomics-based features was boosted by incorporating clinical factors, with time from onset to scan and age being the most important contributors for haematoma expansion and poor functional outcome prediction, respectively. CONCLUSION Radiomics-based features perform better than radiological signs and similarly to clinical factors on the prediction of haematoma expansion and poor functional outcome. Moreover, combining radiomics-based features with clinical factors improves their performance. KEY POINTS • Linear models based on CT radiomics-based features perform better than radiological signs on the prediction of haematoma expansion and poor functional outcome in the context of intracerebral haemorrhage. • Linear models based on CT radiomics-based features perform similarly to clinical factors known to be good predictors. However, combining these clinical factors with radiomics-based features increases their predictive performance.
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Affiliation(s)
- Stefan Pszczolkowski
- Radiological Sciences, Division of Clinical Neuroscience, Precision Imaging Beacon, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. .,Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
| | - José P Manzano-Patrón
- Radiological Sciences, Division of Clinical Neuroscience, Precision Imaging Beacon, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Zhe K Law
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Department of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Kailash Krishnan
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Azlinawati Ali
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rob A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, Precision Imaging Beacon, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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