J Korean Neurosurg Soc.  2021 Sep;64(5):763-775. 10.3340/jkns.2021.0150.

The Osteoporotic Condition as a Predictive Factor for Hemorrhagic Transformation in Acute Cardioembolic Stroke

Affiliations
  • 1Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
  • 2Department of Neurology, Hanyang University Guri Hospital, Guri, Korea

Abstract


Objective
: Hemorrhagic transformation (HT) can be occurred after acute cerebral infarction. HT can worse symptoms in severe cases and adversely affect long-term prognosis. As bone and vascular smooth muscle are composed of type 1 collagen, we aimed to identify a potential relationship between bone mineral density (BMD) and HT after acute cardioembolic stroke.
Methods
: As an indicator of BMD, we used mean frontal skull Hounsfield unit (HU) values on brain computed tomography (CT). Multivariative hazard ratios were calculated using Cox regression analysis to identify whether the osteoporotic condition was an independent predictor of HT after acute cardioembolic stroke.
Results
: This 11-year analysis enrolled 506 patients who diagnosed as acute cardioembolic infarction. The first tertile of skull HU value was an independent predictor of HT development compared to the third tertile (hazard ratio, 2.12; 95% confidence interval, 1.13–3.98; p=0.020). We observed no interactions between age and skull HU with respect to HT statistically.
Conclusion
: The results of this study revealed an association between osteoporotic conditions and HT development after acute cardioembolic stroke. A convenient method to measure the cancellous bone HU value of the frontal skull using brain CT images may be useful for predicting HT in patients with acute cerebral infarction.

Keyword

Bone density; Hemorrhagic transformation; Skull; Embolic stroke

Figure

  • Fig. 1. Measurement of the infarction volume. A : Maximum infarction diameter. B : The largest diameter perpendicular to A. C : Number of images with infarction. D : Slice thickness.

  • Fig. 2. Measurement of the average frontal skull Hounsfield unit (HU) value. The frontal skull HU values in the cancellous bone is measured using the “Linear histogram graph” function.

  • Fig. 3. Trend in infarction volumes according to hemorrhagic transformation (HT). A : Box plot with dot plots showing the trend between HT and infarction volumes. B : Receiver operating characteristic (ROC) curve for HT based on infarction volume. C : Box plot with dot plots showing the trend between HT and infarction volumes divided by sex. D : Receiver operating characteristic curve for HT based on infarction volume divided by sex.

  • Fig. 4. Kaplan-Meier curves showing the cumulative hazards of hemorrhagic transformation (HT) after acute cardioembolic stroke. A : Cumulative hazard of HT. B : Cumulative hazards of HT according to tertile groups of frontal skull Hounsfield unit (HU) values. C : Cumulative hazards of HT according to tertile groups of frontal skull HU values in men. D : Cumulative hazards of HT according to tertile groups of frontal skull HU values in women.

  • Fig. 5. Interaction plots between age and frontal skull Hounsfield units (HUs) with respect to hemorrhagic transformation (HT) after acute cardioembolic stroke. A : Scatter plots with linear regression lines depicting the associations between age and mean frontal skull HU values. B : Interaction between age and frontal skull HU with respect to HT. C : Interaction between age and frontal skull HU with respect to HT in men. D : Interaction between age and frontal skull HU with respect to HT in women.


Reference

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