Clinical neurology and neurosurgery · 2025
Dynamic correlation between brain edema scores and blood-brain barrier permeability predicts the outcome of aneurysmal subarachnoid hemorrhage.
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Zhang Chao, Tang Wenjuan, Yin Pengzhan, Zhao Xintong, Fang Xinggen, Zhou Yunfeng
Аннотация
OBJECTIVE: Cerebral edema and disruption of the blood-brain barrier (BBB) are common consequences of aneurysmal subarachnoid hemorrhage (aSAH) and can be visualized by CT. This study investigated the dynamic correlation between the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) and BBB permeability (BBBP) between admission and during the delayed cerebral ischemia (DCI) time window (DCITW) in patients with aSAH.
METHODS: We investigated 129 patients with aSAH who underwent CT perfusion imaging on admission and during DCITW. The correlations between SEBES and BBBP (measured by Ktrans) and between their dynamic changes (expressed as ΔSEBES and ΔKtrans) were evaluated using Spearman correlation coefficients. Longitudinal changes in both parameters were analyzed. Multivariate logistic regression was employed to identify independent risk factors for DCI and poor outcomes.
RESULTS: A moderate correlation was observed between SEBES and Ktrans both on admission (ρ=0.64, P < 0.001) and during DCITW (ρ=0.65, P < 0.001). A moderately strong correlation (ρ=0.70, P < 0.001) was found between ΔSEBES and ΔKtrans. Both the SEBES (2 [1,2] versus 1 [0,2], P < 0.001) and Ktrans (0.47 ± 0.14 versus 0.41 ± 0.14, P = 0.001) decreased significantly between admission and DCITW. In the adjusted models, the SEBES on admission and during DCITW were independent predictors of DCI (OR 1.92, 95 % CI 1.08-3.43; P = 0.028) and poor outcomes (OR 3.87, 95 % CI 2.14-6.99; P < 0.001).
CONCLUSIONS: Following aSAH, the severity of cerebral edema is significantly correlated with the degree of BBB disruption. Their temporal evolution patterns between admission and DCITW are interrelated. This study provides mechanistic insights into their combined role in predicting clinical outcomes.
METHODS: We investigated 129 patients with aSAH who underwent CT perfusion imaging on admission and during DCITW. The correlations between SEBES and BBBP (measured by Ktrans) and between their dynamic changes (expressed as ΔSEBES and ΔKtrans) were evaluated using Spearman correlation coefficients. Longitudinal changes in both parameters were analyzed. Multivariate logistic regression was employed to identify independent risk factors for DCI and poor outcomes.
RESULTS: A moderate correlation was observed between SEBES and Ktrans both on admission (ρ=0.64, P < 0.001) and during DCITW (ρ=0.65, P < 0.001). A moderately strong correlation (ρ=0.70, P < 0.001) was found between ΔSEBES and ΔKtrans. Both the SEBES (2 [1,2] versus 1 [0,2], P < 0.001) and Ktrans (0.47 ± 0.14 versus 0.41 ± 0.14, P = 0.001) decreased significantly between admission and DCITW. In the adjusted models, the SEBES on admission and during DCITW were independent predictors of DCI (OR 1.92, 95 % CI 1.08-3.43; P = 0.028) and poor outcomes (OR 3.87, 95 % CI 2.14-6.99; P < 0.001).
CONCLUSIONS: Following aSAH, the severity of cerebral edema is significantly correlated with the degree of BBB disruption. Their temporal evolution patterns between admission and DCITW are interrelated. This study provides mechanistic insights into their combined role in predicting clinical outcomes.