ABSTRACT
Objective:To obtain the parameters associated with hematoma morpholoy by finite element analysis(FEA) and investigated their performance on predicting and diagnosis hematoma expansion(HE) in patients with spontaneous intracrebral hemorrhage(SICH).Methods:Patients with SICH who met research criteria were retrospective enrolled between June 2015 and December 2017. Clinical parameters on admission were collected, Perform 2 independent methodology on same patient to analysis the hematoma shape base on computed tomography(CT): Clinical routine method that performed by clinical investigator to identified margin irregularity of hematoma by CT ,and calculated the volume of hematoma by simplify Tada formula(ABC/2);The FEA method performed by FEA investigator and gain the hematoma 3 dimensional morphology and variables, include Volume, Surface area, and The quantity of triangles per square milimet surface(TQOT/mm 2). The HE was defined as volume enlargement of >33% compared with that on addmission. All patients were divided into HE and none HE group ,respectively, ABC/2 and FEA generated thire own HE and none HE group as different volume calcuation. The HE risk factors of ABC/2 and FEA were assessed in univariate and multivariable Logistic regression models. and the risk fators diagnosis value for HE were determined by the receiver operating characteristic(ROC) curves. Results:Total of 127 patients were enrolled, The mean time of symptom onset to hospital admitted was 3.08±1.34 h. There were 34(26.77%) cases HE identifed by ABC/2 and 31(24.41%)by FEA. Althought there are significant different (pearson χ2=53.66, P<0.01) of HE identification between ABC/2 and FEA, the 2 methods has moderate consistency (Kappa=0.65). All patients’ hematoma 3D reconstruction were performed by FEA and general observation show that TQOT/mm 2 most likely correlate to irregularity of hematoma 3D shape. Multivariable Logistic regression models indicated that ICH score( OR=1.79, 95% CI:1.19~2.68)was independent HE risk factor for ABC/2, respectively, TQOT/mm 2≥1.95/mm 2 ( OR=16.99,95% CI:5.98~48.33)and Ultraearly Hematoma Growth,(uHG) ( OR=1.05, 95% CI:1.01~1.09)were independent HE risk factor for FEA. With ROC analysis, both the ICH score of ABC/2 and uHG of FEA have low HE predictive and diagnosis value ,the area under the curve (AUC) were 0.64 and 0.67 respectively. However, TQOT/mm 2 was found to have excellent diagnosis value (AUC:0.9), sensitivity and specificity were 77% and 83% when the cut-off value was 1.95. Panel parameter model (TQOT/mm 2+uHG) was not be found to have a significant higher AUC than single parameter on FEA and the clinical routine parameters panel model (ICH +SB P>180 mmHg on addmission) have a unacceptable AUC(<0.7) as well as single parameters. Conclusions:Hematoma shape could be reconstructed and analysis by FEA and TQOT/mm 2 was likely relevance to hematoma morphology. TQOT/mm 2≥1.95 was indicate to have a better HE predicting and diagnosis value than any other risk factors and clinical parameters panel models in our reaserch.
ABSTRACT
Objective To investigate the role of three-dimensional (3D) reconstruction based parameters of hematoma cavity and encephalocoele in predicting hematoma expansion and hospitalized poor outcome in patients with primary brainstem hemorrhage (PBH). Methods Thirty-two PBH patients met research criterion were enrolled from intensive care unit (ICU) between June 2015 and December 2017. Baseline clinical characteristics, CT images on admission and within 48 h of admission were collected. The 3D reconstruction of hematoma cavity and encephalocoele based on CT images was performed by Mimics10.0, and quantity of triangles per square milimet surface (TQOT/mm2), and hematoma volume (HV) and encephalocoele volume (EV) were obtained. All patients were divided into hematoma expansion group and non-hematoma expansion group according to whether hematoma expansion appeared (hematoma expanded>33％ within 48 h of admission as compared with that on admission), and hospitalized poor outcome group and hospitalized non-poor outcome group according to whether hospitalized poor outcome appeared (modified Rankin scale scores>4 at discharge or hospitalized deaths), respectively. The risk factors of hematoma expansion were investigated by multivariable Logistic regression analysis. Multivariable Cox hazard regression was used to analyze the risk factors of poor outcome; Kaplain-Meier survival curve analysis and Log-rank test were used to compare the differences in survival curves between independent risk factors screened by Cox regression analysis. Results There were 11 patients (34.4％) with hematoma expansion and 14 (43.8％) with ventriculomegaly in 32 patients; in these 11 patients with hematoma expansion, 8 had ventriculomegaly, and the two had positive correlation (rp=0.423, P=0.016). Fifteen patients (46.9％) had poor outcome, in which 11 (34.4％) died in hospital; 5 had hematoma expansion and 8 had ventriculomegaly. Multivariate Logistic regression analysis showed that baseline lactate >2.0 mmol/L (OR=11.986, 95％CI: 1.084-132.552, P=0.043) and TQOT/mm2>2 (OR=10.223, 95％CI: 1.424-73.396, P=0.021) were independent risk factors of hematoma expansion. Baseline HV (HR=1.102, 95％ CI: 1.020-1.143, P=0.002) and EV (HR=3.485, 95％ CI:1.071-11.463, P=0.040) were risk factors of hospitalized poor outcome identified by multivariable Cox analysis. Kaplan-Meier survival analysis showed that the hospitalization days of hospitalized poor outcome were (74.0±10.6) d and (25.5±7.0) d between patients have hematoma expansion Cut-off value of 7 mL, with significant difference (Log-rank: χ2=11.832, P=0.001), and the hospitalization days of hospitalized poor outcome in patients with and without ventriculomegaly were (68.1±9.0) d and (29.9± 8.8) d, respectively, with significant difference (Log-rank: χ2=7.483, P=0.006). Conclusions There is correlation between hematoma expansion and ventriculomegaly; patients with TQOT/mm2>2 might have high risk of hematoma expansion; patients with baseline HV>7 mL and ventriculomegaly would sooner have hospitalized poor outcome.