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Dierksen F, Tran AT, Zeevi T, Maier IL, Qureshi AI, Sanelli PC, Werring DJ, Malhotra A, Falcone GJ, Sheth KN, Payabvash S. Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage. Eur Stroke J 2024; 9:383-390. [PMID: 38179883 DOI: 10.1177/23969873231223814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Perihematomal edema (PHE) represents secondary brain injury and a potential treatment target in intracerebral hemorrhage (ICH). However, studies differ on optimal PHE volume metrics as prognostic factor(s) after spontaneous, non-traumatic ICH. This study examines associations of baseline and 24-h PHE shape features with 3-month outcomes. PATIENTS AND METHODS We included 796 patients from a multicentric trial dataset and manually segmented ICH and PHE on baseline and follow-up CTs, extracting 14 shape features. We explored the association of baseline, follow-up, difference (baseline/follow-up) and temporal rate (difference/time gap) of PHE shape changes with 3-month modified Rankin Score (mRS) - using Spearman correlation. Then, using multivariable analysis, we determined if PHE shape features independently predict outcome adjusting for patients' age, sex, NIH stroke scale (NIHSS), Glasgow Coma Scale (GCS), and hematoma volume. RESULTS Baseline PHE maximum diameters across various planes, main axes, volume, surface, and sphericity correlated with 3-month mRS adjusting for multiple comparisons. The 24-h difference and temporal change rates of these features had significant association with outcome - but not the 24-h absolute values. In multivariable regression, baseline PHE shape sphericity (OR = 2.04, CI = 1.71-2.43) and volume (OR = 0.99, CI = 0. 98-1.0), alongside admission NIHSS (OR = 0.86, CI = 0.83-0.88), hematoma volume (OR = 0.99, CI = 0. 99-1.0), and age (OR = 0.96, CI = 0.95-0.97) were independent predictors of favorable outcomes. CONCLUSION In acute ICH patients, PHE shape sphericity at baseline emerged as an independent prognostic factor, with a less spherical (more irregular) shape associated with worse outcome. The PHE shape features absolute values over the first 24 h provide no added prognostic value to baseline metrics.
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Affiliation(s)
- Fiona Dierksen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Anh T Tran
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ilko L Maier
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Pina C Sanelli
- Department of Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - David J Werring
- Stroke Research Centre, University College London, Queen Square Institute of Neurology, London, UK
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Seyedmehdi Payabvash
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
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Zaman S, Dierksen F, Knapp A, Haider SP, Abou Karam G, Qureshi AI, Falcone GJ, Sheth KN, Payabvash S. Radiomic Features of Acute Cerebral Hemorrhage on Non-Contrast CT Associated with Patient Survival. Diagnostics (Basel) 2024; 14:944. [PMID: 38732358 PMCID: PMC11083693 DOI: 10.3390/diagnostics14090944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The mortality rate of acute intracerebral hemorrhage (ICH) can reach up to 40%. Although the radiomics of ICH have been linked to hematoma expansion and outcomes, no research to date has explored their correlation with mortality. In this study, we determined the admission non-contrast head CT radiomic correlates of survival in supratentorial ICH, using the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial dataset. We extracted 107 original radiomic features from n = 871 admission non-contrast head CT scans. The Cox Proportional Hazards model, Kaplan-Meier Analysis, and logistic regression were used to analyze survival. In our analysis, the "first-order energy" radiomics feature, a metric that quantifies the sum of squared voxel intensities within a region of interest in medical images, emerged as an independent predictor of higher mortality risk (Hazard Ratio of 1.64, p < 0.0001), alongside age, National Institutes of Health Stroke Scale (NIHSS), and baseline International Normalized Ratio (INR). Using a Receiver Operating Characteristic (ROC) analysis, "the first-order energy" was a predictor of mortality at 1-week, 1-month, and 3-month post-ICH (all p < 0.0001), with Area Under the Curves (AUC) of >0.67. Our findings highlight the potential role of admission CT radiomics in predicting ICH survival, specifically, a higher "first-order energy" or very bright hematomas are associated with worse survival outcomes.
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Affiliation(s)
- Saif Zaman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Fiona Dierksen
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Avery Knapp
- Independent Researcher, Guaynabo, PR 00934, USA
| | - Stefan P. Haider
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Gaby Abou Karam
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Adnan I. Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO 65211, USA
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA (K.N.S.)
| | - Kevin N. Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA (K.N.S.)
| | - Seyedmehdi Payabvash
- Department of Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
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Abou Karam G, Chen MC, Zeevi D, Harms BC, Torres-Lopez VM, Rivier CA, Malhotra A, de Havenon A, Falcone GJ, Sheth KN, Payabvash S. Time-Dependent Changes in Hematoma Expansion Rate after Supratentorial Intracerebral Hemorrhage and Its Relationship with Neurological Deterioration and Functional Outcome. Diagnostics (Basel) 2024; 14:308. [PMID: 38337824 PMCID: PMC10855868 DOI: 10.3390/diagnostics14030308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Hematoma expansion (HE) following an intracerebral hemorrhage (ICH) is a modifiable risk factor and a treatment target. We examined the association of HE with neurological deterioration (ND), functional outcome, and mortality based on the time gap from onset to baseline CT. METHODS We included 567 consecutive patients with supratentorial ICH and baseline head CT within 24 h of onset. ND was defined as a ≥4-point increase on the NIH stroke scale (NIHSS) or a ≥2-point drop on the Glasgow coma scale. Poor outcome was defined as a modified Rankin score of 4 to 6 at 3-month follow-up. RESULTS The rate of HE was higher among those scanned within 3 h (124/304, 40.8%) versus 3 to 24 h post-ICH onset (53/263, 20.2%) (p < 0.001). However, HE was an independent predictor of ND (p < 0.001), poor outcome (p = 0.010), and mortality (p = 0.003) among those scanned within 3 h, as well as those scanned 3-24 h post-ICH (p = 0.043, p = 0.037, and p = 0.004, respectively). Also, in a subset of 180/567 (31.7%) patients presenting with mild symptoms (NIHSS ≤ 5), hematoma growth was an independent predictor of ND (p = 0.026), poor outcome (p = 0.037), and mortality (p = 0.027). CONCLUSION Despite decreasing rates over time after ICH onset, HE remains an independent predictor of ND, functional outcome, and mortality among those presenting >3 h after onset or with mild symptoms.
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Affiliation(s)
- Gaby Abou Karam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
| | - Min-Chiun Chen
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
| | - Dorin Zeevi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
| | - Bendix C. Harms
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
| | - Victor M. Torres-Lopez
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; (V.M.T.-L.); (C.A.R.); (A.d.H.); (G.J.F.); (K.N.S.)
| | - Cyprien A. Rivier
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; (V.M.T.-L.); (C.A.R.); (A.d.H.); (G.J.F.); (K.N.S.)
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
| | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; (V.M.T.-L.); (C.A.R.); (A.d.H.); (G.J.F.); (K.N.S.)
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; (V.M.T.-L.); (C.A.R.); (A.d.H.); (G.J.F.); (K.N.S.)
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; (V.M.T.-L.); (C.A.R.); (A.d.H.); (G.J.F.); (K.N.S.)
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA; (G.A.K.); (M.-C.C.); (D.Z.); (B.C.H.); (A.M.)
- Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT 06520, USA
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Xia X, Zhang X, Cui J, Jiang Q, Guan S, Liang K, Wang H, Wang C, Huang C, Dong H, Han K, Meng X. Difference of mean Hounsfield units (dHU) between follow-up and initial noncontrast CT scan predicts 90-day poor outcome in spontaneous supratentorial acute intracerebral hemorrhage with deep convolutional neural networks. Neuroimage Clin 2023; 38:103378. [PMID: 36931003 PMCID: PMC10036865 DOI: 10.1016/j.nicl.2023.103378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES This study aimed to investigate the usefulness of a new non-contrast CT scan (NCCT) sign called the dHU, which represented the difference in mean Hounsfield unit values between follow-up and the initial NCCT for predicting 90-day poor functional outcomes in acute supratentorial spontaneous intracerebral hemorrhage(sICH) using deep convolutional neural networks. METHODS A total of 377 consecutive patients with sICH from center 1 and 91 patients from center 2 (external validation set) were included. A receiver operating characteristic (ROC) analysis was performed to determine the critical value of dHU for predicting poor outcome at 90 days. Modified Rankin score (mRS) >3 or >2 was defined as the primary and secondary poor outcome, respectively. Two multivariate models were developed to test whether dHU was an independent predictor of the two unfavorable functional outcomes. RESULTS The ROC analysis showed that a dHU >2.5 was a critical value to predict the poor outcomes (mRS >3) in sICH. The sensitivity, specificity, and accuracy of dHU >2.5 for poor outcome prediction were 37.5%, 86.0%, and 70.6%, respectively. In multivariate models developed after adjusting for all elements of the ICH score and hematoma expansion, dHU >2.5 was an independent predictor of both primary and secondary poor outcomes (OR = 2.61, 95% CI [1.32,5.13], P = 0.006; OR = 2.63, 95% CI [1.36,5.10], P = 0.004, respectively). After adjustment for all possible significant predictors (p < 0.05) by univariate analysis, dHU >2.5 had a positive association with primary and secondary poor outcomes (OR = 3.25, 95% CI [1.52,6.98], P = 0.002; OR = 3.42, 95% CI [1.64,7.15], P = 0.001). CONCLUSIONS The dHU of hematoma based on serial CT scans is independently associated with poor outcomes after acute sICH, which may help predict clinical evolution and guide therapy for sICH patients.
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Affiliation(s)
- Xiaona Xia
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiaoqian Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jiufa Cui
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qingjun Jiang
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Shuai Guan
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Kongming Liang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing 100080, China
| | - Hao Wang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing 100080, China
| | - Chao Wang
- Department of Radiology, Jiaozhou People's Hospital, Qingdao, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing 100080, China
| | - Hao Dong
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing 100080, China
| | - Kai Han
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing 100080, China
| | - Xiangshui Meng
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
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