Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2)
Background and purpose Intracerebral haemorrhage volume (ICHV) is prognostically important but does not account for intracranial volume (ICV) and cerebral parenchymal volume (CPV). We assessed measures of intracranial compartments in acute ICH using computerised tomography scans and whether ICHV/ICV...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
|
| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2022/10/06/svn-2021-001375.full |
| _version_ | 1798029386561093632 |
|---|---|
| author | Joanna M Wardlaw Philip M Bath Lisa J Woodhouse Nikola Sprigg Zhe Kang Law Kailash Krishnan Rob A Dineen |
| author_facet | Joanna M Wardlaw Philip M Bath Lisa J Woodhouse Nikola Sprigg Zhe Kang Law Kailash Krishnan Rob A Dineen |
| author_sort | Joanna M Wardlaw |
| collection | DOAJ |
| description | Background and purpose Intracerebral haemorrhage volume (ICHV) is prognostically important but does not account for intracranial volume (ICV) and cerebral parenchymal volume (CPV). We assessed measures of intracranial compartments in acute ICH using computerised tomography scans and whether ICHV/ICV and ICHV/CPV predict functional outcomes. We also assessed if cistern effacement, midline shift, old infarcts, leukoaraiosis and brain atrophy were associated with outcomes.Methods Data from 133 participants from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial trial were analysed. Measures included ICHV (using ABC/2) and ICV (XYZ/2) (by independent observers); ICHV, ICV and CPV (semiautomated segmentation, SAS); atrophy (intercaudate distance, ICD, Sylvian fissure ratio, SFR); midline shift; leukoaraiosis and cistern effacement (visual assessment). The effects of these measures on death at day 4 and poor functional outcome at day 90 (modified Rankin scale, mRS of >3) was assessed.Results ICV was significantly different between XYZ and SAS: mean (SD) of 1357 (219) vs 1420 (196), mean difference (MD) 62 mL (p<0.001). There was no significant difference in ICHV between ABC/2 and SAS. There was very good agreement for ICV measured by SAS, CPV, ICD, SFR, leukoaraiosis and cistern score (all interclass correlations, n=10: interobserver 0.72-0.99, intraobserver 0.73-1.00). ICHV/ICV and ICHV/CPV were significantly associated with mRS at day 90, death at day 4 and acute neurological deterioration (all p<0.05), similar to ICHV. Midline shift and cistern effacement at baseline were associated with poor functional outcome but old infarcts, leukoaraiosis and brain atrophy were not.Conclusions Intracranial compartment measures and visual estimates are reproducible. ICHV adjusted for ICH and CPV could be useful to prognosticate in acute stroke. The presence of midline shift and cistern effacement may predict outcome but the mechanisms need validation in larger studies. |
| first_indexed | 2024-04-11T19:23:34Z |
| format | Article |
| id | doaj.art-c3f2a58e8f9a4079bb43972f1e0d1b28 |
| institution | Directory Open Access Journal |
| issn | 2059-8696 |
| language | English |
| last_indexed | 2024-04-11T19:23:34Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj.art-c3f2a58e8f9a4079bb43972f1e0d1b282022-12-22T04:07:13ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2021-001375Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2)Joanna M Wardlaw0Philip M Bath1Lisa J Woodhouse2Nikola Sprigg3Zhe Kang Law4Kailash Krishnan5Rob A Dineen6Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UKStroke Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UKStroke Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UKStroke Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UKStroke Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UKStroke, Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK5 Department of Radiology, University of Nottingham, Nottingham, UKBackground and purpose Intracerebral haemorrhage volume (ICHV) is prognostically important but does not account for intracranial volume (ICV) and cerebral parenchymal volume (CPV). We assessed measures of intracranial compartments in acute ICH using computerised tomography scans and whether ICHV/ICV and ICHV/CPV predict functional outcomes. We also assessed if cistern effacement, midline shift, old infarcts, leukoaraiosis and brain atrophy were associated with outcomes.Methods Data from 133 participants from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial trial were analysed. Measures included ICHV (using ABC/2) and ICV (XYZ/2) (by independent observers); ICHV, ICV and CPV (semiautomated segmentation, SAS); atrophy (intercaudate distance, ICD, Sylvian fissure ratio, SFR); midline shift; leukoaraiosis and cistern effacement (visual assessment). The effects of these measures on death at day 4 and poor functional outcome at day 90 (modified Rankin scale, mRS of >3) was assessed.Results ICV was significantly different between XYZ and SAS: mean (SD) of 1357 (219) vs 1420 (196), mean difference (MD) 62 mL (p<0.001). There was no significant difference in ICHV between ABC/2 and SAS. There was very good agreement for ICV measured by SAS, CPV, ICD, SFR, leukoaraiosis and cistern score (all interclass correlations, n=10: interobserver 0.72-0.99, intraobserver 0.73-1.00). ICHV/ICV and ICHV/CPV were significantly associated with mRS at day 90, death at day 4 and acute neurological deterioration (all p<0.05), similar to ICHV. Midline shift and cistern effacement at baseline were associated with poor functional outcome but old infarcts, leukoaraiosis and brain atrophy were not.Conclusions Intracranial compartment measures and visual estimates are reproducible. ICHV adjusted for ICH and CPV could be useful to prognosticate in acute stroke. The presence of midline shift and cistern effacement may predict outcome but the mechanisms need validation in larger studies.https://svn.bmj.com/content/early/2022/10/06/svn-2021-001375.full |
| spellingShingle | Joanna M Wardlaw Philip M Bath Lisa J Woodhouse Nikola Sprigg Zhe Kang Law Kailash Krishnan Rob A Dineen Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) Stroke and Vascular Neurology |
| title | Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) |
| title_full | Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) |
| title_fullStr | Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) |
| title_full_unstemmed | Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) |
| title_short | Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2) |
| title_sort | measures of intracranial compartments in acute intracerebral haemorrhage data from the rapid intervention with glyceryl trinitrate in hypertensive stroke 2 trial right 2 |
| url | https://svn.bmj.com/content/early/2022/10/06/svn-2021-001375.full |
| work_keys_str_mv | AT joannamwardlaw measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT philipmbath measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT lisajwoodhouse measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT nikolasprigg measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT zhekanglaw measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT kailashkrishnan measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 AT robadineen measuresofintracranialcompartmentsinacuteintracerebralhaemorrhagedatafromtherapidinterventionwithglyceryltrinitrateinhypertensivestroke2trialright2 |