Early predictors of hematoma resorption rate in medically treated patients with spontaneous supratentorial hemorrhage

Automated segmentation of ventricular volumes and subarachnoid hemorrhage from computed tomography images: Evaluation of a rule-based pipeline approach

Changes in ventricular size, related to brain edema and hydrocephalus, as well as the extent of hemorrhage are associated with adverse outcomes in patients with subarachnoid hemorrhage (SAH). Frequently, these are measured manually using consecutive non-contrast computed tomography scans. Here, we developed a rule-based approach which incorporates both intensity and spatial normalization and utilizes user-defined thresholds and anatomical templates to segment both lateral ventricle (LV) and SAH blood volumes automatically from CT images. The algorithmic segmentations were evaluated against two expert neuroradiologists on representative slices from 20 admission scans from aneurysmal SAH patients. Previous methods have been developed to automate this time-consuming task, but they lack user feedback and are hard to implement due to large-scale data and complex design processes. Our results using automatic ventricular segmentation aligned well with expert reviewers with a median Dice coefficient of 0.81, AUC of 0.91, sensitivity of 81%, and precision of 84%. Automatic segmentation of SAH blood was most reliable near the base of the brain with a median Dice coefficient of 0.51, an AUC of 0.75, precision of 68%, and sensitivity of 50%. Ultimately, we developed a rule-based method that is easily adaptable through user feedback, generates spatially normalized segmentations that are comparable regardless of brain morphology or acquisition conditions, and automatically segments LV with good overall reliability and basal SAH blood with good precision. Our approach could benefit longitudinal studies in patients with SAH by streamlining assessment of edema and hydrocephalus progression, as well as blood resorption.

Three-dimensional ultrasound for evaluation of residual placental volume after conservative management of placenta accreta spectrum in a single tertiary center

OBJECTIVE

To evaluate the residual placental volume and correlated factors using three-dimensional ultrasound (3D) in patients with placenta accreta spectrum (PAS) after conservative management.

MATERIALS AND METHODS

From January 2005 to December 2023, we retrospectively reviewed patients with PAS who underwent prophylactic transcatheter arterial embolization and retained the placenta in situ. The residual placental volume was assessed using 3D ultrasound equipped with virtual organ computer-aided analysis. We determined the resorption rate of the residual placenta (RRRP) and analyzed correlated factors.

RESULTS

Eighteen patients with PAS were included. The mean RRRP was 152.64 ± 147.97 cm3/month. The median natural resorption time was 5.5 months. According to Spearman's correlation, only the initial placental volume was significantly associated with RRRP (p = 0.001, correlation coefficient = 0.701). Initial placental volume was not associated with postpartum hemorrhage, postpartum infection, resume of menstruation, subsequent pregnancy, or mean white blood cell count.

CONCLUSION

3D ultrasound is useful for measuring the volume of residual placenta. A larger initial placental volume was associated with a higher RRRP.

A comparative study of fractional anisotropy measures and ICH score in predicting functional outcomes after intracerebral hemorrhage

BACKGROUND

Improved prognostication during the acute phase of intracerebral hemorrhage (ICH) could influence goals of care. We investigated the utility of diffusion tensor imaging (DTI)-derived data obtained during the acute phase of ICH in predicting outcome, compared with the ICH score.

METHODS

We measured fractional anisotropy (FA) values in 5 slices below the level of the lesion on the affected and unaffected corticospinal tracts (CST) and in the cerebral peduncles (CPs) in 32 patients with supratentorial ICH who had DTI MRI within 4 days after ictus. We calculated the FA ratio (rFA = FAaffected side/FAunaffected side), and examined the value of the ICH score and rFA in predicting functional outcome assessed by modified Ranking Scale (mRS) at follow-up, using ROC analyses.

RESULTS

The rFA values at the CPs level, but not the 5 slices below the lesion, were significantly lower in the group with poor functional outcome (defined as mRS > 2) than in those with good functional outcome (0.96 ± 0.14 vs. 0.99 ± 0.08, p = 0.025). The ICH score had greater areas under ROC curve in predicting functional outcome compared to the mean rFA (AUC 0.74 vs. 0.44; p = 0.01 for mRS > 2; and 0.84 vs. 0.40; p < 0.001 for mRS > 3).

CONCLUSIONS

The prognostic value of the ICH score surpassed that of DTI-derived data during the acute phase of ICH in this cohort of patients. Prospective and larger studies are needed to validate our findings and to assess the prognostic role of various DTI-derived measures at different times following ICH.