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Objective <p>Perihematomal edema (PHE) represents a major secondary injury mechanism following intracerebral hemorrhage (ICH). This study aims to evaluate the impact of early PHE expansion on functional outcomes in patients with deep ICH.</p> Methods <p>Patients with deep intracerebral hemorrhage who underwent baseline computed tomography (CT) within 24&#xa0;h of symptom onset and a follow-up CT within 72&#xa0;h were included. Absolute PHE increase was defined as the difference in PHE volume between the follow-up and baseline CT scans. Poor outcome was defined as a modified Rankin Scale score &gt; 3 at 3 months. A multivariate logistic regression model was applied to assess the association between early absolute PHE increase and outcomes in patients with basal ganglia or thalamic hemorrhage. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of absolute PHE increase.</p> Results <p>A total of 178 patients were enrolled, including 101 with basal ganglia ICH and 71 with thalamic ICH. In multivariate logistic regression analysis, absolute PHE increase was independently associated with poor outcomes in both basal ganglia (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.18–3.89, <i>P</i> = 0.012) and thalamic hemorrhage (OR 2.19, 95% CI 1.05–4.55, <i>P</i> = 0.036). ROC analysis identified 6.72&#xa0;mL for basal ganglia PHE and 3.48&#xa0;mL for thalamic PHE as the optimal cut-off values for predicting poor outcomes. Furthermore, early PHE expansion was inversely associated with 90-day functional independence in basal ganglia ICH (OR 0.10, 95% CI 0.02–0.63, <i>P</i> = 0.014).</p> Conclusions <p>Early absolute PHE growth predicts poor functional outcomes in deep ICH. Its adverse effect on functional independence is most evident in basal ganglia hemorrhage, underscoring the need for location-specific PHE assessment.</p>

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Association of Location-Specific Perihematomal Edema with Clinical Outcomes in Deep Intracerebral Hemorrhage

  • 期刊论文

  • 发表日期：

    2026年4月6日

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  • Mengqiu Zhang,
  • Xiao Hu,
  • Peijun Qian,
  • Sunhong Yan,
  • Lei Zhu,
  • Jie Shen,
  • Zijie Wang,
  • Juan Li,
  • Chu Chen,
  • Yue Sun,
  • Qi Li

摘要

Objective

Perihematomal edema (PHE) represents a major secondary injury mechanism following intracerebral hemorrhage (ICH). This study aims to evaluate the impact of early PHE expansion on functional outcomes in patients with deep ICH.

Methods

Patients with deep intracerebral hemorrhage who underwent baseline computed tomography (CT) within 24 h of symptom onset and a follow-up CT within 72 h were included. Absolute PHE increase was defined as the difference in PHE volume between the follow-up and baseline CT scans. Poor outcome was defined as a modified Rankin Scale score > 3 at 3 months. A multivariate logistic regression model was applied to assess the association between early absolute PHE increase and outcomes in patients with basal ganglia or thalamic hemorrhage. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of absolute PHE increase.

Results

A total of 178 patients were enrolled, including 101 with basal ganglia ICH and 71 with thalamic ICH. In multivariate logistic regression analysis, absolute PHE increase was independently associated with poor outcomes in both basal ganglia (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.18–3.89, P = 0.012) and thalamic hemorrhage (OR 2.19, 95% CI 1.05–4.55, P = 0.036). ROC analysis identified 6.72 mL for basal ganglia PHE and 3.48 mL for thalamic PHE as the optimal cut-off values for predicting poor outcomes. Furthermore, early PHE expansion was inversely associated with 90-day functional independence in basal ganglia ICH (OR 0.10, 95% CI 0.02–0.63, P = 0.014).

Conclusions

Early absolute PHE growth predicts poor functional outcomes in deep ICH. Its adverse effect on functional independence is most evident in basal ganglia hemorrhage, underscoring the need for location-specific PHE assessment.