Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage

Yang, Wen‐Song; Zhang, Shu‐Qiang; Shen, Yiqing; Xiao, Wei; Zhao, Libo; Xie, Xiong‐Fei; Deng, Lan; Li, Xin‐Hui; Lv, Xin‐Ni; Lv, Fajin; Dowlatshahi, Dar; Li, Qi; Xie, Peng

doi:10.1161/jaha.120.018248

Cited by 18 publications

(21 citation statements)

References 36 publications

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“…15 Previous studies have established that IVH growth (an increase of IVH volume by comparing the initial and follow-up CTs or as a delayed development of IVH on subsequent CT) is intimately tied to the with patients' neurological outcomes. 4,5 Yogendrakumar et al 6 also proposed that the definition of RHE exhibit diagnostic accuracy in the prediction of worse outcome superior to the conventional definition of hematoma expansion. These studies collectively indicated that recognition of RHE is an important step toward precision medicine for treatment target with the potential to improve outcomes in patients with ICH.…”

Section: Discussionmentioning

confidence: 99%

“…3 Accumulating investigations have demonstrated that the inclusion of IVH growth into the conventional definition of hematoma expansion, that is, revised hematoma expansion (RHE), can boost the predictive accuracy of outcomes in patients with ICH. [4][5][6] Recently, an indicator termed the frequency of imaging markers (FIM) has been proposed for the prediction of hematoma expansion with better performance. 7 It is not clear whether the FIM can be used in predicting IVH growth or RHE.…”

Section: Introductionmentioning

confidence: 99%

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Is the frequency of imaging markers still a predictor for revised intracerebral hemorrhage expansion?

Song,

Zhou,

Cheng

et al. 2024

European Stroke Journal

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Introduction: Frequency of imaging markers (FIM) has been described as a novel predictor for hematoma expansion after intracerebral hemorrhage (ICH). A revised definition of hematoma expansion that incorporates intraventricular hemorrhage (IVH) growth, that is, revised hematoma expansion (RHE), has also been proposed. Nevertheless, the associations between FIM and IVH growth or RHE remains unexplored. The objective of this study was to assess the influence and performance of the FIM on two types. Materials and Methods: Patient selection and variables were based on our published protocol. FIM was defined as the ratio of the number of imaging markers to the onset-to-neuroimaging time. The association between FIM and two definitions was tested by multivariate analysis. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the FIM on two definitions were also evaluated. Results: There were 303 (20.36%) and 583 (39.18%) subjects in the IVH growth and RHE, respectively. Multivariate analysis demonstrated that FIM was associated with both IVH growth and RHE (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.60–2.39; OR = 15.01, 95% CI = 10.51–21.43, respectively). The optimal cutoff points for FIM to predict IVH growth and RHE were 0.63 and 0.62, with AUC, sensitivity, specificity, PPV, and NPV of 0.66, 0.50, 0.78, 0.36, and 0.86 versus 0.80, 0.60, 0.93, 0.84, and 0.78, respectively. Discussion and Conclusion: FIM was not only a predictor of IVH growth, but also of RHE. These findings may have important clinical implications for decision-making based on risk stratification of patients with ICH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is the frequency of imaging markers still a predictor for revised intracerebral hemorrhage expansion?

Song,

Zhou,

Cheng

et al. 2024

European Stroke Journal

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“…Regions of interest (ROIs) were delineated by using Analyze 11.0 Software and ITK-SNAP 3.8.0 Software [10,11]. HE and revised HE were both calculated as previously reported [12]. All NCCT markers were rated on axial NCCT images for the following nine markers, namely (1) irregular (IRR) shape, (2) satellite sign, (3) island sign, (4) heterogenous (HET) density, (5) swirl sign, (6) black hole sign, (7) blend sign, (8) fluid sign, and (9) hypodensities, using definitions proposed by the International NCCT Study Group (Supplementary Materials Table S1) [4,5,[13][14][15][16][17][18][19][20][21].…”

Section: Image Analysismentioning

confidence: 99%

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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“…Many markers based on computerized tomography (CT) are increasingly used for predicting hematoma enlargement (HE), ICH prognosis, and perihematomal edema (PHE), such as black hole signs, blend signs, and island signs [ 8 , 9 ]. Several studies recently suggested that ICH patients with subarachnoid extension of hemorrhage (SAHE) seemed to have unfavorable outcomes [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

Wang

Bian

et al. 2023

BMC Neurol

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Objective Our study aimed to investigate the association between the subarachnoid extension of intracranial hemorrhage (SAHE) and clinical outcomes in patients with supratentorial intracerebral hemorrhage (ICH). Methods We analyzed the data from a prospective, multi-center, and registry-based database. Two experienced investigators independently assessed ICH imaging data. We compared baseline characteristics and follow-up outcomes. Multivariable logistic regression analysis was used to evaluate the association between SAHE and poor clinical outcomes. We also performed Kaplan–Meier curves and Cox proportional hazards regression analyses to analyze whether SAHE was relevant to a higher mortality rate. Results A total of 931 patients were included in this study (SAHE vs. no SAHE, 121 [13.0%] vs. 810 [87.0%]). Patients with SAHE had more severe neurological deficits, higher scores of the mRS, and more remarkable mortality rates at follow-up (all p values < 0.05). In multivariable-adjusted models, SAHE was independently associated with a higher risk of poor outcomes (adjusted OR [95%CI]: 2.030 [1.142–3.608] at 3 months; 2.348 [1.337–4.123] at 1 year). In addition, SAHE remained an independent association with an increased death rate at 1 year (adjusted HR [95%CI], 1.314[1.057–1.635]). In the subgroup analysis, the correlation between SAHE and prognosis exists in patients with lobar or deep ICH. Conclusions SAHE is independently associated with poor outcomes in patients with supratentorial ICH. It may provide a promising target for developing new predictive tools targeting ICH.

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Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage

Cited by 18 publications

References 36 publications

Is the frequency of imaging markers still a predictor for revised intracerebral hemorrhage expansion?

Is the frequency of imaging markers still a predictor for revised intracerebral hemorrhage expansion?

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

Subarachnoid extension and unfavorable outcomes in patients with supratentorial intracerebral hemorrhage

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