Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Abstract

OBJECTIVE The presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores. METHODS The authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1-3 and 4-5 subgroups for analysis. RESULTS On univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895-0.979), GCS score (OR 3.422, 95% CI 1.9-6.164), and ventricular density (OR 0.937, 95% CI 0.878-0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1-3 and 4-5. CONCLUSIONS This study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

A scoring model to predict the prognosis of patients with poor-grade aneurysmal subarachnoid hemorrhage

“…There are also some other risk factors that have been raised in recent articles but have not been widely recognized. Intraventricular hemorrhage was also regarded as a risk factor for poor outcomes in many literatures [31]. It has been veri ed in our univariate analysis, however, eliminated in nal multivariate regression analysis.…”

Bloody Ventriculography: Intracerebral Hemorrhage Artistically Casting the Ventricular System’s Anatomy Into a Bird’s Head

“…Moreover, this interesting CT image highlights the significance of each anatomical configuration of the ventricular system in different individuals. Which in infants, for example, served as an invaluable tool to predict the development of hydrocephalus after intraventricular hemorrhage (IVH) [ 15 , 16 ].…”

Predicting intraventricular hemorrhage growth with a machine learning-based, radiomics-clinical model

“…Demographic data (age and sex), medical history (history of hypertension, diabetes, hypercholesterolemia, hemorrhage, and alcohol consumption), initial clinical data (Glasgow coma scale, time to initial CT, and baseline ICH volume), and laboratory data (blood glucose, platelet count, international normalized ratio, and activated partial thromboplastin time) were recorded after admission. The Glasgow Outcome Scale (GOS) was evaluated at discharge, and poor outcome was defined as having a GOS of ≤3 [ 33 , 34 ].…”

“…We also evaluated IVH severity by calculating the Graeb score [ 19 ] from the baseline and follow-up CT images. A Graeb score of ≥6 was defined as severe IVH based on the literature for IVH severity indicators [ 28 , 33 ].…”