Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Arba, Francesco; Rinaldi, Chiara; Boulouis, Grégoire; Fainardi, Enrico; Charidimou, Andreas; Morotti, Andrea

doi:10.1177/17474930211061639

Cited by 16 publications

(20 citation statements)

References 75 publications

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“…Indeed, the lack of external validation is the main factor for a low RQS ( 35 ). Standardization of high-quality image-extracted data may be helpful for clinical decision support systems ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of non-enhanced computer tomography-based radiomics for predicting hematoma expansion: A meta-analysis

Jiang

Wang

et al. 2023

Front. Oncol.

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BackgroundThis meta-analysis aimed to assess the efficacy of radiomics using non-enhanced computed tomography (NCCT) for predicting hematoma expansion in patients with spontaneous intracerebral hemorrhage.MethodsThroughout the inception of the project to April 11, 2022, a comprehensive search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials. The methodological quality of studies in this analysis was assessed by the radiomics quality scoring system (RQS). A meta-analysis of radiomic studies based on NCCT for predicting hematoma expansion in patients with intracerebral hemorrhage was performed. The efficacy of the radiomics approach and non-contrast CT markers was compared using network meta-analysis (NMA).ResultsTen articles comprising a total of 1525 patients were quantitatively analyzed for hematoma expansion after cerebral hemorrhage using radiomics. Based on the included studies, the mean RQS was 14.4. The AUC value (95% confidence interval) of the radiomics model was 0.80 (0.76-0.83). Five articles comprising 846 patients were included in the NMA. The results synthesized according to Bayesian NMA revealed that the predictive ability of the radiomics model outperformed most of the NCCT biomarkers.ConclusionsThe NCCT-based radiomics approach has the potential to predict hematoma expansion. Compared to NCCT biomarkers, we recommend a radiomics approach. Standardization of the radiomics approach is required for further clinical implementation.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=324034, identifier [CRD42022324034].

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Section: Discussionmentioning

confidence: 99%

Efficacy of non-enhanced computer tomography-based radiomics for predicting hematoma expansion: A meta-analysis

Jiang

Wang

et al. 2023

Front. Oncol.

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“…One of the main factors associated with high mortality is hematoma expansion, which can occur in the first 24 hours after the onset of ICH [3][4][5][6] . Factors associated with hematoma expansion are related to the patient (low hemoglobin, hematocrit, and platelet count or anticoagulant therapy) 3,5,[7][8][9] and hematoma characteristics on NCCT at baseline (initial volume, shape, and density of the hematoma) 1,3,5,10,11 .…”

Section: Introductionmentioning

confidence: 99%

Hounsfield units on noncontrast computed tomography predict hematoma expansion in patients with intracerebral hemorrhage

Gonzalez-Rodriguez¹,

Bueno-Martinez²,

Diaz-Montoya³

et al. 2023

JMEXFRI

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Introduction: Hounsfield units (HU) have been proposed as a prognostic marker of hematoma expansion in patients with intracerebral hemorrhage (ICH). The aim of this study was to determine the optimal HU value for predicting hematoma expansion on noncontrast computed tomography (NCCT) in patients diagnosed with ICH. Material and Methods: Prospective cohort study of patients with ICH. Baseline cranial NCCT was performed within 8 hours of symptom onset and an NCCT follow-up within 72 hours of the baseline examination. HU and the shape and density of the hematoma were assessed at baseline NCCT. The optimal HU cut-off value for predicting hematoma expansion was determined by ROC analysis. Results: Fifty patients diagnosed with ICH were included. There were 28 (56.0%) men and 22 (44.0%) women. Their mean age was 57.8 ± 16.97 years. Hematoma expansion was present in 14 (28.0%) cases. At baseline NCCT, the mean HU was significantly lower in patients with expansion (61.1 ± 2.8) than in patients without hematoma expansion (69.2 ± 5.5) (p < 0.001). A value equal to or less than 64.2 HU on baseline NCCT was defined as the optimal cut-off point for predicting hematoma expansion. Sensitivity was 78.6%, specificity 86.1%, and the AUC was 0.914 (95% CI, 0.834-0.993) (p < 0.001). Conclusion: In this study, for the first time, a value equal to or less than 64.2 HU by ROC analysis on baseline NCCT was defined as the optimal cut-off point for predicting hematoma expansion in patients with ICH.

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“…Specifically on non-contrast computed tomography (CT), there may be significant overlap between heterogeneous shape, density, and various non-contrast markers of ICH expansion [ 4 ]. Diagnostic accuracy of non-contrast CT markers has been variable in previous studies, with sensitivity and specificity values being suboptimal for any meaningful implementation in clinical practice or trial design [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Increased Prognostic Yield by Combined Assessment of Non-Contrast Computed Tomography Markers of Antithrombotic-Related Spontaneous Intracerebral Hemorrhage Expansion

Katsanos

Gupta

Morotti

et al. 2022

JCM

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Background and aims: The utility of proposed non-contrast computed tomography (NCCT) markers for the prediction of hematoma expansion in patients with antithrombotic-related spontaneous intracerebral hemorrhage (ICH) is limited. Additionally, there is significant overlap between different suggested ICH shape and density markers. Methods: We assessed the prognostic yield for hematoma expansion of a combined score incorporating features of ICH shape irregularity (satellite sign and/or Barras score ≥ 3), heterogeneous ICH density (swirl sign and/or Barras score ≥ 3) on baseline NCCT and timing from ICH onset to NCCT. Results: We evaluated data from 79 patients with antithrombotic-related spontaneous ICH (32% with hematoma expansion). Swirl (84% vs. 39%) and satellite signs (20% vs. 7%) on baseline NCCT were significantly more prevalent (p < 0.001) in patients with hematoma expansion. Patients with hematoma expansion had more irregular and heterogeneous bleeds on baseline NCCT scans, as quantified by higher (p < 0.001) Barras shape (4 (4–5) vs. 3 (2–4)) and density scores (4 (3–5) vs. 2 (1–3)), respectively. The overall diagnostic yield of the combined score (area under the curve: 0.86, 95%CI: 0.78–0.94) significantly outperformed (p < 0.001) the diagnostic yield of each individual marker. Scores of 4 or 5 in the combined score were associated with a sensitivity of 60.0%, specificity of 90.7%, overall diagnostic accuracy of 81.0%, positive likelihood ratio (LR) of 6.48, negative LR of 0.44, positive predictive value (PV) of 0.76 and negative PV of 0.83. Conclusion: Combined NCCT marker assessment seems to increase the prognostic accuracy for hematoma expansion in antithrombotic-related spontaneous ICH patients.

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Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Cited by 16 publications

References 75 publications

Efficacy of non-enhanced computer tomography-based radiomics for predicting hematoma expansion: A meta-analysis

Efficacy of non-enhanced computer tomography-based radiomics for predicting hematoma expansion: A meta-analysis

Hounsfield units on noncontrast computed tomography predict hematoma expansion in patients with intracerebral hemorrhage

Increased Prognostic Yield by Combined Assessment of Non-Contrast Computed Tomography Markers of Antithrombotic-Related Spontaneous Intracerebral Hemorrhage Expansion

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