Abstract：
BACKGROUND: The pathological mechanisms following aneurysmal subarachnoid hemorrhage (SAH) are poorly understood. Limited clinical evidence exists on the association between cerebrospinal fluid (CSF) volume and the risk of delayed cerebral ischemia (DCI) or cerebral vasospasm (CV). In this study, we raised the hypothesis that the amount of CSF or its ratio to hemorrhage blood volume, as determined from non-contrast Computed Tomography (NCCT) images taken on admission, could be a significant predictor for CV and DCI.
METHODS: The pilot study included a retrospective analysis of NCCT scans of 49 SAH patients taken shortly after an aneurysm rupture (33 males, 16 females, mean age 56.4 ± 15 years). The SynthStrip and Slicer3D software tools were used to extract radiological factors - CSF, brain, and hemorrhage volumes from the NCCT images. The \"pure\" CSF volume (VCSF) was estimated in the range of [-15, 15] Hounsfield units (HU).
RESULTS: VCSF was negatively associated with the risk of CV occurrence (p = 0.0049) and DCI (p = 0.0069), but was not associated with patients\' outcomes. The hemorrhage volume (VSAH) was positively associated with an unfavorable outcome (p = 0.0032) but was not associated with CV/DCI. The ratio VSAH/VCSF was positively associated with, both, DCI (p = 0.031) and unfavorable outcome (p = 0.002). The CSF volume normalized by the brain volume showed the highest characteristics for DCI prediction (AUC = 0.791, sensitivity = 0.80, specificity = 0.812) and CV prediction (AUC = 0.769, sensitivity = 0.812, specificity = 0.70).
CONCLUSIONS: It was demonstrated that \"pure\" CSF volume retrieved from the initial NCCT images of SAH patients (including CV, Non-CV, DCI, Non-DCI groups) is a more significant predictor of DCI and CV compared to other routinely used radiological biomarkers. VCSF could be used to predict clinical course as well as to personalize the management of SAH patients. Larger multicenter clinical trials should be performed to test the added value of the proposed methodology.
METHODS: The pilot study included a retrospective analysis of NCCT scans of 49 SAH patients taken shortly after an aneurysm rupture (33 males, 16 females, mean age 56.4 ± 15 years). The SynthStrip and Slicer3D software tools were used to extract radiological factors - CSF, brain, and hemorrhage volumes from the NCCT images. The \"pure\" CSF volume (VCSF) was estimated in the range of [-15, 15] Hounsfield units (HU).
RESULTS: VCSF was negatively associated with the risk of CV occurrence (p = 0.0049) and DCI (p = 0.0069), but was not associated with patients\' outcomes. The hemorrhage volume (VSAH) was positively associated with an unfavorable outcome (p = 0.0032) but was not associated with CV/DCI. The ratio VSAH/VCSF was positively associated with, both, DCI (p = 0.031) and unfavorable outcome (p = 0.002). The CSF volume normalized by the brain volume showed the highest characteristics for DCI prediction (AUC = 0.791, sensitivity = 0.80, specificity = 0.812) and CV prediction (AUC = 0.769, sensitivity = 0.812, specificity = 0.70).
CONCLUSIONS: It was demonstrated that \"pure\" CSF volume retrieved from the initial NCCT images of SAH patients (including CV, Non-CV, DCI, Non-DCI groups) is a more significant predictor of DCI and CV compared to other routinely used radiological biomarkers. VCSF could be used to predict clinical course as well as to personalize the management of SAH patients. Larger multicenter clinical trials should be performed to test the added value of the proposed methodology.
摘要：
背景：动脉瘤性蛛网膜下腔出血（SAH）后的病理机制知之甚少。关于脑脊液（CSF）体积与迟发性脑缺血（DCI）或脑血管痉挛（CV）风险之间的关系的临床证据有限。在这项研究中,我们提出了一个假设，即脑脊液的量或其与出血血容量的比率，根据入院时拍摄的非对比计算机断层扫描（NCCT）图像确定，可能是CV和DCI的重要预测因子。
方法：试点研究包括对49例SAH患者在动脉瘤破裂后不久进行的NCCT扫描的回顾性分析（33例男性，16位女性,平均年龄56.4±15岁)。SynthStrip和Slicer3D软件工具用于提取放射因子-CSF，大脑,和NCCT图像的出血量。“纯”CSF体积（VCSF）估计在[-15,15]Hounsfield单位（HU）的范围内。
结果：VCSF与CV发生（p=0.0049）和DCI（p=0.0069）的风险呈负相关，但与患者预后无关。出血量（VSAH）与不良结局呈正相关（p=0.0032），但与CV/DCI无关。VSAH/VCSF比值与,两者,DCI（p=0.031）和不利结果（p=0.002）。由脑体积标准化的CSF体积显示了DCI预测（AUC=0.791，灵敏度=0.80，特异性=0.812）和CV预测（AUC=0.769，灵敏度=0.812，特异性=0.70）的最高特征。
结论：从SAH患者的初始NCCT图像中检索到的“纯”CSF体积（包括CV，非CV,与其他常规使用的放射学生物标志物相比，DCI，非DCI组）是DCI和CV的更重要的预测因子。VCSF可用于预测SAH患者的临床病程以及个性化管理。应进行较大的多中心临床试验，以测试拟议方法的附加值。
方法：试点研究包括对49例SAH患者在动脉瘤破裂后不久进行的NCCT扫描的回顾性分析（33例男性，16位女性,平均年龄56.4±15岁)。SynthStrip和Slicer3D软件工具用于提取放射因子-CSF，大脑,和NCCT图像的出血量。“纯”CSF体积（VCSF）估计在[-15,15]Hounsfield单位（HU）的范围内。
结果：VCSF与CV发生（p=0.0049）和DCI（p=0.0069）的风险呈负相关，但与患者预后无关。出血量（VSAH）与不良结局呈正相关（p=0.0032），但与CV/DCI无关。VSAH/VCSF比值与,两者,DCI（p=0.031）和不利结果（p=0.002）。由脑体积标准化的CSF体积显示了DCI预测（AUC=0.791，灵敏度=0.80，特异性=0.812）和CV预测（AUC=0.769，灵敏度=0.812，特异性=0.70）的最高特征。
结论：从SAH患者的初始NCCT图像中检索到的“纯”CSF体积（包括CV，非CV,与其他常规使用的放射学生物标志物相比，DCI，非DCI组）是DCI和CV的更重要的预测因子。VCSF可用于预测SAH患者的临床病程以及个性化管理。应进行较大的多中心临床试验，以测试拟议方法的附加值。
