The Hounsfield Unit of Perihematomal Edema Is Associated With Poor Clinical Outcomes in Intracerebral Hemorrhage

Huan, Renzheng; Li, Yi; Tan, Jiahe; Tang, Jun; Huang, Ning; Yuan, Chao

doi:10.1016/j.wneu.2020.11.025

Cited by 9 publications

(17 citation statements)

References 19 publications

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“…38 In all four studies included in this pooled effect size the OR had been adjusted for multiple factors (Supplemental Table 4), including at least age, ICH volume and severity of ICH by either GCS score or NIHSS score. 22,24,30,38 Heterogeneity among these four studies was moderate (I 2 44%). Quality assessment showed an intermediate 22,30 to low 24,38 risk of bias in these studies.…”

Section: Resultsmentioning

confidence: 98%

The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis

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Cunningham

et al. 2023

European Stroke Journal

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Purpose: Perihaematomal oedema (PHO) formation has gained increasing interest as a therapeutic target after spontaneous intracerebral haemorrhage (ICH). Whether PHO contributes to poor outcome is unclear. We aimed to determine the association between PHO and outcome in patients with spontaneous ICH. Method: We searched five databases up to 17 November 2021 for studies of ⩾10 adults with ICH reporting the presence of PHO and outcome. We assessed risk of bias, extracted aggregate data and used random effects meta-analysis to pool studies that reported odds ratios (OR) with 95% confidence intervals (CI). Primary outcome was poor functional outcome defined as modified Rankin Scale score of 3–6 at 3 months. Additionally, we assessed PHO growth and poor outcome at any time of follow-up. We prospectively registered the protocol in PROSPERO (CRD42020157088). Findings: We identified 12,968 articles, of which we included 27 studies ( n = 9534). Eighteen studies reported an association between larger PHO volume and poor outcome, six a neutral result and three an inverse relationship. Larger absolute PHO volume was associated with poor functional outcome at 3 months (OR per mL increase of absolute PHO 1.03, 95% CI 1.00–1.06, I2 44%, four studies). Additionally, PHO growth was associated with poor outcome (OR 1.04, 95% CI 1.02–1.06, I2 0%, seven studies). Discussion: In patients with spontaneous ICH, larger PHO volume is associated with poor functional outcome at 3 months. These findings support the development and investigation of new therapeutic interventions targeting PHO formation to evaluate if reduction of PHO improves outcome after ICH.

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Section: Resultsmentioning

confidence: 98%

The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis

Cliteur

Sondag

Cunningham

et al. 2023

European Stroke Journal

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“…PHE is an independent prognostic factor for death or dependency. The attenuation of the PHE at 72 h after onset has also been shown to predict outcome, with lower attenuation values (suggestive of a more intense PHE) being predictive of a poor outcome [ 73 ]. Baseline hematoma volume is also associated with PHE growth [ 69 ].…”

Section: Neuroimaging Of Ichmentioning

confidence: 99%

“…Irregularly shaped hematomas have been associated with increased risk of expansion during the first 24 h of onset [66]. The Perihematomal edema hematoma expansion and outcome Odds ratio 0.59 [73] Hematoma expansion Outcome and mortality Odds ratio 4.59 [10] Intraventricular extension hematoma expansion and outcome Sensitivity 43%, specificity 85% [88] Spot sign hematoma expansion Sensitivity 53%, specificity 88% [95] Swirl sign Hematoma expansion Sensitivity 45%, specificity 79% [98] Black hole sign Hematoma expansion Sensitivity 30%, specificity 91%…”

Section: Hematoma Shape and Densitymentioning

confidence: 99%

Computed tomography in acute intracerebral hemorrhage: neuroimaging predictors of hematoma expansion and outcome

et al. 2022

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Intracerebral hemorrhage (ICH) accounts for 10–20% of all strokes worldwide and is associated with serious outcomes, including a 30-day mortality rate of up to 40%. Neuroimaging is pivotal in diagnosing ICH as early detection and determination of underlying cause, and risk for expansion/rebleeding is essential in providing the correct treatment. Non-contrast computed tomography (NCCT) is the most used modality for detection of ICH, identification of prognostic markers and measurements of hematoma volume, all of which are of major importance to predict outcome. The strongest predictors of 30-day mortality and functional outcome for ICH patients are baseline hematoma volume and hematoma expansion. Even so, exact hematoma measurement is rare in clinical routine practice, primarily due to a lack of tools available for fast, effective, and reliable volumetric tools. In this educational review, we discuss neuroimaging findings for ICH from NCCT images, and their prognostic value, as well as the use of semi-automatic and fully automated hematoma volumetric methods and assessment of hematoma expansion in prognostic studies.

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“…In patients with ICH, BBB permeability as estimated by dynamic contrast-enhanced MRI (DCE-MRI) has been associated with perihematomal edema (PHE) volumes (15,18,19). The formation of PHE has recently been associated with poor outcome after ICH (20)(21)(22)(23) and has gained increasing interest as a potential therapeutic target to prevent secondary brain injury after ICH. Thus, insight into the mechanisms of PHE formation is important.…”

Section: Introductionmentioning

confidence: 99%

Cerebral small vessel disease and perihematomal edema formation in spontaneous intracerebral hemorrhage

et al. 2022

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ObjectiveBlood-brain barrier (BBB) dysfunction is implicated in the pathophysiology of cerebral small vessel disease (cSVD)-related intracerebral hemorrhage (ICH). The formation of perihematomal edema (PHE) is presumed to reflect acute BBB permeability following ICH. We aimed to assess the association between cSVD burden and PHE formation in patients with spontaneous ICH.MethodsWe selected patients with spontaneous ICH who underwent 3T MRI imaging within 21 days after symptom onset from a prospective observational multicenter cohort study. We rated markers of cSVD (white matter hyperintensities, enlarged perivascular spaces, lacunes and cerebral microbleeds) and calculated the composite score as a measure of the total cSVD burden. Perihematomal edema formation was measured using the edema extension distance (EED). We assessed the association between the cSVD burden and the EED using a multivariable linear regression model adjusting for age, (log-transformed) ICH volume, ICH location (lobar vs. non-lobar), and interval between symptom onset and MRI.ResultsWe included 85 patients (mean age 63.5 years, 75.3% male). Median interval between symptom onset and MRI imaging was 6 days (IQR 1–19). Median ICH volume was 17.0 mL (IQR 1.4–88.6), and mean EED was 0.54 cm (SD 0.17). We found no association between the total cSVD burden and EED (B = −0.003, 95% CI −0.003–0.03, p = 0.83), nor for any of the individual radiological cSVD markers.ConclusionWe found no association between the cSVD burden and PHE formation. This implies that mechanisms other than BBB dysfunction are involved in the pathophysiology of PHE.

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The Hounsfield Unit of Perihematomal Edema Is Associated With Poor Clinical Outcomes in Intracerebral Hemorrhage

Cited by 9 publications

References 19 publications

The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis

The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis

Computed tomography in acute intracerebral hemorrhage: neuroimaging predictors of hematoma expansion and outcome

Cerebral small vessel disease and perihematomal edema formation in spontaneous intracerebral hemorrhage

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