Non-contrast CT markers of intracerebral hematoma expansion: a reliability study

Nehme, Ahmad; Ducroux, Célina; Panzini, Marie-Andrée; Bard, Céline; Bereznyakova, Olena; Boisseau, William; Deschaintre, Yan; Diestro, Jose Danilo Bengzon; Guilbert, F; Jacquin, Grégory; Maallah, Mohamed Taoubane; Nelson, Kristoff; Padilha, Igor Gomes; Poppe, Alexandre Y; Rioux, Bastien; Roy, Daniel; Touma, Lahoud; Weill, Alain; Gioia, Laura; Létourneau-Guillon, Laurent

doi:10.1007/s00330-022-08710-w

Cited by 13 publications

(7 citation statements)

References 46 publications

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“…Semiquantitative measurements were error-prone for calculating the correct diameter of the hemorrhage for assessing the satellite sign (Figure 1C,D) and density differences for the black hole sign or blend sign (Figure 1E-G). In line with this, raters from different clinical backgrounds also tended to obtain higher proportions of positive ratings of NCCT markers according to a recently published study [27]. Variabilities in the ratings of the IRR shape, heterogenous density, and island sign may be further influenced by differences in the slice position of the region of interest (ROI), which should be placed on the axial slice with the largest cross-sectional area of the hematoma (Figure 1B,J) [5].…”

Section: Discussionsupporting

confidence: 60%

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: 60%

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

et al. 2022

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“…Although imaging markers had a positive effect on HE prediction, their diagnostic performance was underwhelming. 19,20 Our study showed that FIM >0.63 was a promising alternative. It reached an AUC value of 0.83 and International Journal of Stroke, 19 (2) significantly outperformed the other indicators.…”

Section: Discussionmentioning

confidence: 76%

The frequency of imaging markers adjusted for time since symptom onset in intracerebral hemorrhage: A novel predictor for hematoma expansion

Song,

Cheng,

Zhang

et al. 2023

International Journal of Stroke

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Background: Hematoma expansion (HE) is common in patients with intracerebral hemorrhage (ICH), and associated with a worse outcome. Imaging makers and shorter time from symptom onset are both associated with HE, but prognostic scores based on these parameters individually have not been satisfactory. We hypothesized that a score including both imaging markers of expansion, and time of onset, would improve prediction. Methods: Patients with supratentorial ICH within 6 h after onset were consecutively recruited from six centers between January 2018 and August 2022. Three markers were used: hypodensities, the blend sign, and the island sign. We first defined FIM as the relationship between the number of imaging markers and OCT. The time adjusted frequency of imaging markers (FIM) was defined as the ratio of the number of imaging markers to the onset-to-initial imaging time. Multivariate analysis was performed to determine the relationship between FIM and HE. Receiver operating curve analysis was used to identify potential threshold values of FIM that optimally predict HE. In addition, the sensitivity, specificity, positive and negative predictive values (PPVs and NPVs), and the area under the curve (AUC) of the optimal cut-off in predicting HE were calculated. Results: In total, 1488 patients were eligible for inclusion, of whom 418 had incident HE. Multivariate analysis showed that age, male sex, baseline Glasgow Coma Scale score, presence of intraventricular hemorrhage, and FIM were independent predictors of HE (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.97–0.99; OR = 1.73, 95% CI: 1.28–2.35; OR = 0.87, 95% CI: 0.83–0.92; OR = 0.42, 95% CI: 0.28–0.62; OR = 7.82, 95% CI: 5.86–10.42, respectively). The optimal cut-off point for FIM in predicting HE was 0.63, with sensitivity, specificity, PPV, NPV, and AUC values of 0.69, 0.89, 0.71, 0.88, and 0.83, respectively. Conclusions: The FIM adjusted for time since symptom onset is a significant predictor of HE. Its use may allow improved prediction of those patients with ICH who develop HE, and the score may be clinically applicable in the management of patients with ICH.

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“…This technique appears promising for HE prediction, but it remains largely unknown whether it is also effective for predicting RHE and requires further investigation in the future. Although the performance of conventional NCCT signs is inferior to that of the above technologies, these indicators have convenient and rapid characteristics in clinical practice as favorable prognostic predictors [ 11 19 32 ], especially in emergency settings or primary health institutions [ 33 34 35 ].…”

Section: Discussionmentioning

confidence: 99%

Combining Non-Contrast CT Signs With Onset-to-Imaging Time to Predict the Evolution of Intracerebral Hemorrhage

Song,

Qiu,

Zhang

et al. 2024

Korean J Radiol

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Objective This study aimed to determine the predictive performance of non-contrast CT (NCCT) signs for hemorrhagic growth after intracerebral hemorrhage (ICH) when stratified by onset-to-imaging time (OIT). Materials and Methods 1488 supratentorial ICH within 6 h of onset were consecutively recruited from six centers between January 2018 and August 2022. NCCT signs were classified according to density (hypodensities, swirl sign, black hole sign, blend sign, fluid level, and heterogeneous density) and shape (island sign, satellite sign, and irregular shape) features. Multivariable logistic regression was used to evaluate the association between NCCT signs and three types of hemorrhagic growth: hematoma expansion (HE), intraventricular hemorrhage growth (IVHG), and revised HE (RHE). The performance of the NCCT signs was evaluated using the positive predictive value (PPV) stratified by OIT. Results Multivariable analysis showed that hypodensities were an independent predictor of HE (adjusted odds ratio [95% confidence interval] of 7.99 [4.87–13.40]), IVHG (3.64 [2.15–6.24]), and RHE (7.90 [4.93–12.90]). Similarly, OIT (for a 1-h increase) was an independent inverse predictor of HE (0.59 [0.52–0.66]), IVHG (0.72 [0.64–0.81]), and RHE (0.61 [0.54–0.67]). Blend and island signs were independently associated with HE and RHE (10.60 [7.36–15.30] and 10.10 [7.10–14.60], respectively, for the blend sign and 2.75 [1.64–4.67] and 2.62 [1.60–4.30], respectively, for the island sign). Hypodensities demonstrated low PPVs of 0.41 (110/269) or lower for IVHG when stratified by OIT. When OIT was ≤ 2 h, the PPVs of hypodensities, blend sign, and island sign for RHE were 0.80 (215/269), 0.90 (142/157), and 0.83 (103/124), respectively. Conclusion Hypodensities, blend sign, and island sign were the best NCCT predictors of RHE when OIT was ≤ 2 h. NCCT signs may assist in earlier recognition of the risk of hemorrhagic growth and guide early intervention to prevent neurological deterioration resulting from hemorrhagic growth.

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Non-contrast CT markers of intracerebral hematoma expansion: a reliability study

Cited by 13 publications

References 46 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

The frequency of imaging markers adjusted for time since symptom onset in intracerebral hemorrhage: A novel predictor for hematoma expansion

Combining Non-Contrast CT Signs With Onset-to-Imaging Time to Predict the Evolution of Intracerebral Hemorrhage

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