Predictive value of matrix metalloproteinase-9 combined with magnetic resonance spectroscopy for delayed cerebral edema after spontaneous intracerebral hemorrhage

Jing Sun^1*Lei Chen²

• ¹Shanghai Panoramic Cloud Medical Imaging Diagnosis Center, Shanghai, China
• ²Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China

Objective: This paper was launched to unearth the predictive value of matrix metalloproteinase (MMP)-9 combined with magnetic resonance spectroscopy (MRS) for delayed cerebral edema after spontaneous intracerebral hemorrhage (SICH).Methods: Patients with head CT suggestive of SICH were retrospectively included. Serum MMP-9 levels were measured within 24 h of the onset of the disease, and MRS was performed on day 3 after admission, and NAA/Cr values of edematous areas in MRS were measured and calculated separately. Delayed cerebral edema was defined as a 1-cm increase in the diameter of the peripheral edema around an intracerebral hematoma within 14 d compared with the peripheral diameter of the edema at 7 d, as confirmed by dynamic CT. Demographics of the delayed cerebral edema group were compared with those of the control group, as well as baseline clinical data. Multivariate logistic regression analysis was applied to evaluate independent predictors of delayed cerebral edema. The predictive value of MMP-9 and MRS-related indices for delayed cerebral edema was assessed by using receiver operating characteristic (ROC) curves.Results: Eighty SICH patients were included, 27 in the delayed cerebral edema group and 53 in the non-delayed cerebral edema group (control group). Univariate analysis revealed higher MMP9 levels and NAA/Cr values in the delayed cerebral edema group relative to the control group (both P < 0.05). Multivariate logistic regression analysis disclosed that increased MMP-9 levels (OR = 1.041, 95%CI: 1.019~1.064, P < 0.001) and decreased NAA/Cr values (OR = 0.095, 95%CI: 0.015~0.586, P = 0.011) were independent predictive factors for the development of delayed cerebral edema after SICH. ROC curve analysis reflected that the area under the curve (AUC) of serum MMP-9 and NAA/Cr values alone and the combination of the 2 indices for predicting the development of delayed cerebral edema after SICH were 0.835, 0.734, and 0.874, respectively.The combination of serum MMP-9 detection and MRS has a high efficacy in predicting the occurrence of delayed cerebral edema in SICH, providing guidance for subsequent clinical diagnosis and treatment.