| Objective:To investigate the association between the imaging markers of cerebral small vessel disease(CSVD)and early hematoma expansion(HE)in patients with spontaneous intracerebral hemorrhages(sICH).Methods:Analysis of data were collected from 216 patients with sICH in the Affiliated Hospital of Qingdao University between January 1,2015 and December 31,2019.All subjects received noncontrast CT(NCCT)within 6 hours after symptom onset.Within 24 hours after the initial NCCT examination,they were reexamed to determine whether HE occurred(NCCT reexamination showed hematoma volume increased > 33% or > 6ml compared with the baseline),and brain MR examination were completed within 48 hours after onset.The baseline hematoma volume and NCCT signs,including blend sign,black hole sign,swirl sign,island sign and satellite sign were evaluated based on the initial NCCT.The presence of CSVD imaging markers,including lacunar(LA),enlarged perivascular space(EPVS),cerebral microbleeds(CMBs),white matter hyperintensity(WMH)and cortical superficial siderosis(CSS)were assessed on MRI.All subjects were divided into two groups according to whether HE or not,and the general information,NCCT signs and subtypes of CSVD,the total burden of CSVD,and NCCT signs combined with CSVD subtypes were compared between the two groups.Multiple logistic regression analysis was used to determine independent risk factors for HE.The receiver operating characteristic curve(ROC)curve was used to evaluate the predictive ability of different imaging markers for HE in sICH patients.Result:1.A total of 216 patients with sICH were included,their age was 57 ± 15 years,113(61.6%)were male,88(40.7%)had HE.Baseline hematoma volume(8.5ml vs 5.9ml,P = 0.023),serum calcium level(2.08mg/L vs 2.2mg/L,P < 0.001),admission NIHSS score(5 vs 4,P = 0.017)and MRS score(3 vs 2,P = 0.02)score was significantly higher than that in non-HE group.In addition,NCCT signs(81.8% vs 39.8%,P < 0.001)were significantly higher than those without HE.2.The presence of CMBs(P < 0.001),WMH(P = 0.002),CSS(P < 0.001)was significantly higher than that of non-HE group,but there was no significant difference in the detection rates of LA(P = 0.168)and EPVS(P = 0.103)between the two groups.By multivariate logistic regression analysis,we found that the serum calcium level(odds ratio [OR] =0.0395,95% confidence interval [CI] = 0.004-0.238,P = 0.001),any NCCT signs(OR =3.275,95%CI = 1.492-7.188,P = 0.003),CMBS grade 4(OR = 3.591,95%CI = 1.146-11.25,P = 0.028),CSS(OR = 3.008,95%CI = 1.214-7.452,P = 0.017)was independently predicted early HE.3.The CSVD total burden score in the HE group was significantly higher than that in the non-HE group(P = 0.036),but the CSVD total burden score of 1-4 was not an independent risk factor for early HE after multivariate Logistic regression analysis.4.The the detection rates of CMBs grading combined with NCCT signs(P < 0.001),WMH combined with NCCT signs(P < 0.001),and CSS combined with NCCT signs(P < 0.001)were higher in HE group than in non-HE group,and the differences were statistically significant.However,there was no significant difference in the occurrence rate of LA combined with NCCT signs(P = 0.127)and EPVS combined with NCCT signs(P = 0.863)between the two groups.Multivariate Logistic regression analysis showed that CMBs grade3 combined with NCCT signs(OR = 3.39,95%CI = 1.035-11.102,P = 0.044),CMBs grade4 combined with NCCT signs(OR = 5.473,95%CI = 1.352-22.161,P = 0.017)and CSS combined with NCCT signs(OR = 3.544,95%CI = 1.215-10.336,P = 0.021)were independent risk factors for early HE.5.ROC curve analysis showed that the sensitivity of NCCT signs,CMBs and CSS for predicting HE in sICH patients were 81.8%,64.8% and 34.1%,respectively,and the specificity was 60.2%,60.9% and 89.1%,respectively.The prediction sensitivity of CMBs combined with NCCT signs and CSS combined with NCCT signs was lower than that of single imaging markers(59.1% and 30.7%,respectively),while the specificity was higher than that of single imaging markers(78.1% and 93.7%,respectively).Conclusion:1.The incidence of early HE in sICH patients was 40.7%.2.CSVD is closely related to the early occurrence of HE in sICH patients,and CMBs grade4 and CSS are independent risk factors for the early occurrence of HE in sICH patients.3.The total burden score of CSVD was significantly different from the early occurrence of HE in sICH patients,but it was not an independent risk factor for HE.4.CMBs grade 3 combined with NCCT,CMBs Grade 4 combined with NCCT,and CSS combined with NCCT were also independent predictors of early HE risk in sICH patients.5.CMBs and CSS can predict the risk of HE in early sICH,but the prediction ability is general.CMBs grading combined with NCCT signs,CSS combined with NCCT signs showed higher specificity but lower sensitivity in predicting HE than single imaging markers.6.Serum calcium level is also an independent risk factor for early HE in sICH patients. |
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