Abstract 185: New Predictive Scoring Scale for Prospective Symptomatic Hemorrhage of Cavernous Malformation in Adults
Purpose: The purpose of this study was to assess the risk factors of prospective symptomatic hemorrhage in a large adult CM population. We also proposed a new predictive scoring scale for estimating the hemorrhage-free survival in patients with multiple risk factors.
Materials and Methods: A total of 326 adult patients (over 18 years) with 410 CM were retrospectively evaluated during the mean follow-up of 31.4 months. Prospective symptomatic CM hemorrhage was defined as following: 1) a new clinical symptoms, and 2) radiographical hemorrhage including intra-or extralesional signal change or size increase>20%. A new CM classification was suggested: type I, typical mulberry appearance; type IIa, uniloculated CM in the hemisphere; type IIb, deep-seated uniloculated CM. Other risk factors, such as previous hemorrhage, the size and the location of CM, multiplicity and combined venous anomaly, were also evaluated using univariate and multivariate statistical analyses. Kaplan-Meier analysis was performed to assess the cumulative survival rate without symptomatic hemorrhage.
Results: Prior symptomatic hemorrhage (p<0.001), multiplicity (p=0.04) and CM type (p<0.001) were associated with prospective hemorrhage. A multivariate analysis disclosed prior symptomatic hemorrhage (HR, 4.46; p<0.001) and type IIb (HR, 1.95; p=0.04) were significant factors. The cumulative survival rate without symptomatic hemorrhage at five years reached the significance (p<0.001): prior hemorrhage, 52.84% vs. without hemorrhage, 85.61%; type I, 74.50% vs. type IIa, 84.76% vs. type IIb, 53.17%. According to these results, new predictive scoring scale for symptomatic hemorrhage was proposed, which was the sum of both scores from that previous symptomatic hemorrhage was scored 1, and without hemorrhage was scored 0, and from that type I and type IIa were scored 0 and type IIb was scored 1. The cumulative survival rate without symptomatic hemorrhage at five years was 89.01% at 0 point, 60.74% at 1 point, and 37.58% at 2 point.
Conclusion: New predictive scoring system, including prior history of symptomatic hemorrhage and deep-seated CM without mulberry appearance, may be feasible for measuring the hemorrhage-free survival in adult CM patients with multiple risk factors.
- © 2012 by American Heart Association, Inc.