Kailash Krishnan
Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2)
Krishnan, Kailash; Law, Zhe Kang; Woodhouse, Lisa J; Dineen, Rob A; Sprigg, Nikola; Wardlaw, Joanna M; Bath, Philip M
Authors
Zhe Kang Law
Dr LISA WOODHOUSE L.Woodhouse@nottingham.ac.uk
Research Fellow
ROBERT DINEEN rob.dineen@nottingham.ac.uk
Professor of Neuroradiology
NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine
Joanna M Wardlaw
PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine
Abstract
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.
Citation
Krishnan, K., Law, Z. K., Woodhouse, L. J., Dineen, R. A., Sprigg, N., Wardlaw, J. M., & Bath, P. M. (2023). 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, 8(2), 151-160. https://doi.org/10.1136/svn-2021-001375
Journal Article Type | Article |
---|---|
Acceptance Date | May 11, 2022 |
Online Publication Date | Oct 6, 2022 |
Publication Date | 2023-04 |
Deposit Date | Oct 18, 2022 |
Publicly Available Date | Oct 18, 2022 |
Journal | Stroke and Vascular Neurology |
Electronic ISSN | 2059-8696 |
Publisher | BMJ Publishing Group |
Peer Reviewed | Peer Reviewed |
Volume | 8 |
Issue | 2 |
Pages | 151-160 |
DOI | https://doi.org/10.1136/svn-2021-001375 |
Keywords | Cardiology and Cardiovascular Medicine; Neurology (clinical) |
Public URL | https://nottingham-repository.worktribe.com/output/12598099 |
Publisher URL | https://svn.bmj.com/content/8/2/151 |
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Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2)
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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