Inter- and Intrarater Agreement of Spot Sign and Noncontrast CT Markers for Early Intracerebral Hemorrhage Expansion

Nawabi, Jawed; Elsayed, Sarah; Kniep, Helge; Sporns, Peter; Schlunk, Frieder; McDonough, Rosalie; Broocks, Gabriel; Dührsen, Lasse; Schön, Gerhard; Thomalla, Götz; Fiehler, Jens; Hanning, Uta

doi:10.3390/jcm9041020

Cited by 12 publications

(15 citation statements)

References 28 publications

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“…In this study, we aimed to determine the link between the level of experience in raters and the reliability of the assessment of NCCT markers. Our previous results demonstrated good-to-excellent levels of inter-and intrarater reliability and contribute to the results presented by Dowlatshahi et al [6,7]. However, the different levels of experience amongst raters with a radiological background may result in significant interobserver variability and differences in the diagnostic accuracy for predicting acute HE.…”

Section: Discussionsupporting

confidence: 80%

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Diagnostic Accuracy and Reliability of Noncontrast Computed Tomography Markers for Acute Hematoma Expansion among Radiologists

et al. 2022

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Background: Noncontrast Computed Tomography (NCCT) features are promising markers for acute hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH). It remains unclear whether accurate identification of these markers is also reliable in raters with different levels of experience. Methods: Patients with acute spontaneous ICH admitted at four tertiary centers in Germany and Italy were retrospectively included from January 2017 to June 2020. In total, nine NCCT markers were rated by one radiology resident, one radiology fellow, and one neuroradiology fellow with different levels experience in ICH imaging. Interrater reliabilities of the resident and radiology fellow were evaluated by calculated Cohen’s kappa (κ) statistics in reference to the neuroradiology fellow who was referred as the gold standard. Gold-standard ratings were evaluated by calculated interrater κ statistics. Global interrater reliabilities were evaluated by calculated Fleiss kappa statistics across all three readers. A comparison of receiver operating characteristics (ROCs) was used to evaluate differences in the diagnostic accuracy for predicting acute hematoma expansion (HE) among the raters. Results: Substantial-to-almost-perfect interrater concordance was found for the resident with interrater Cohen’s kappa from 0.70 (95% CI 0.65–0.81) to 0.96 (95% CI 0.94–0.98). The interrater Cohen’s kappa for the radiology fellow was moderate to almost perfect and ranged from 0.58 (95% CI 0.52–0.65) to 94 (95% CI 92–0.97). The intrarater gold-standard Cohen’s kappa was almost perfect and ranged from 0.79 (95% CI 0.78–0.90) to 0.98 (95% CI 0.78–0.90). The global interrater Fleiss kappa ranged from 0.62 (95%CI 0.57–0.66) to 0.93 (95%CI 0.89–0.97). The diagnostic accuracy for the prediction of acute hematoma expansion (HE) was different for the island sign and fluid sign, with p-values < 0.05. Conclusion: The NCCT markers had a substantial-to-almost-perfect interrater agreement among raters with different levels of experience. Differences in the diagnostic accuracy for the prediction of acute HE were found in two out of nine NCCT markers. The study highlights the promising utility of NCCT markers for acute HE prediction.

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Section: Discussionsupporting

confidence: 80%

“…Consensus criteria proposed by the international NCCT study group have aimed at paving the way toward a standardization of NCCT marker nomenclature [5]. Further clinical studies have reported high levels of reliability for these markers [6,7]. However, these markers were analyzed by raters with a strong expertise in ICH neuroimaging.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy and Reliability of Noncontrast Computed Tomography Markers for Acute Hematoma Expansion among Radiologists

et al. 2022

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“…All the imaging analyses were performed by different trained raters at each participating site, blinded to the main outcomes of interest and a good interrater reliability for hypodensities and spot sign identification has been previously shown (Cohen’s K >0.8). 16,17…”

Section: Methodsmentioning

confidence: 99%

Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion

Morotti

Boulouis

Nawabi

et al. 2023

Stroke

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BACKGROUND: Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign. METHODS: Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994–2015, prospective), Hamilton, Canada (2010–2016, retrospective), Berlin, Germany (2014–2019, retrospective), Chongqing, China (2011–2015, retrospective), Pavia, Italy (2017–2019, prospective), Ferrara, Italy (2010–2019, retrospective), Brescia, Italy (2020–2021, retrospective), and Bologna, Italy (2015–2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison. RESULTS: A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55–3.80]; P <0.001). The inclusion of noncontrast computed tomography hypodensities improved the discrimination of the 4 predictors model (area under the curve, 0.67 [95% CI, 0.64–0.69] versus 0.71 [95% CI, 0.69–0.74]; P =0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64–0.73] versus 0.74 [95% CI, 0.70–0.78]; P =0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70–0.78]). CONCLUSIONS: Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.

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“…NCCT markers can be categorized into ICH shape features and ICH density features and consensus criteria for their detection and interpretation have been recently proposed to harmonize terminology and use in future studies [ 37 ]. Of the reported markers, especially hypodensities within the hyperdense hematoma ( Figure 2 ), the blend-sign and the black hole sign have been reported to show the highest sensitivity and specificity for prediction of ICH expansion and a good interrater reliability [ 37 , 38 , 39 , 40 , 41 , 42 ]. Of note, NCCT markers are not simply an epiphenomenon of the spot sign and if CTA images are available, use of both NCCT and CTA markers may provide additional yield in the stratification of HE risk [ 43 ].…”

Section: Imaging To Predict Ich Expansionmentioning

confidence: 99%

Neuroimaging of Acute Intracerebral Hemorrhage

Sporns

Psychogios

Boulouis

et al. 2021

JCM

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Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.

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Inter- and Intrarater Agreement of Spot Sign and Noncontrast CT Markers for Early Intracerebral Hemorrhage Expansion

Cited by 12 publications

References 28 publications

Diagnostic Accuracy and Reliability of Noncontrast Computed Tomography Markers for Acute Hematoma Expansion among Radiologists

Diagnostic Accuracy and Reliability of Noncontrast Computed Tomography Markers for Acute Hematoma Expansion among Radiologists

Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion

Neuroimaging of Acute Intracerebral Hemorrhage

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