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Cheng X, Zhang W, Wu M, Jiang N, Guo Z, Leng X, Song J, Jin H, Sun X, Zhang F, Qin J, Yan X, Cai Z, Luo Y, Yang Y, Liu J. A prediction of hematoma expansion in hemorrhagic patients using a novel dual-modal machine learning strategy. Physiol Meas 2021; 42. [PMID: 34198278 DOI: 10.1088/1361-6579/ac10ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/01/2021] [Indexed: 11/11/2022]
Abstract
Objective.Hematoma expansion is closely associated with adverse functional outcomes in patients with intracerebral hemorrhage (ICH). Prediction of hematoma expansion would therefore be of great clinical significance. We therefore attempted to predict hematoma expansion using a dual-modal machine learning (ML) strategy which combines information from non-contrast computed tomography (NCCT) images and multiple clinical variables.Approach.We retrospectively identified 140 ICH patients (57 with hematoma expansion) with 5616 NCCT images of hematoma (2635 with hematoma expansion) and 10 clinical variables. The dual-modal ML strategy consists of two steps. The first step is to derive a mono-modal predictor from a deep convolutional neural network using solely NCCT images. The second step is to achieve a dual-modal predictor by combining the mono-modal predictor with 10 clinical variables to predict hematoma growth using a multi-layer perception network.Main results. For the mono-modal predictor, the best performance was merely 69.5% in accuracy with solely the NCCT images, whereas the dual-modal predictor could boost the accuracy greatly to be 86.5% by combining clinical variables.Significance.To our knowledge, this is the best performance from using ML to predict hematoma expansion. It could be potentially useful as a screening tool for high-risk patients with ICH, though further clinical tests would be necessary to show its performance on a larger cohort of patients.
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Affiliation(s)
- Xinpeng Cheng
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China.,Department of Neurology 2, Brain Hospital, Weifang People's Hospital, Weifang ,261021, Shandong, People's Republic of China
| | - Wei Zhang
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518000, People's Republic of China
| | - Menglu Wu
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518000, People's Republic of China
| | - Nan Jiang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Zhenni Guo
- Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, 999077, People's Republic of China
| | - Jianing Song
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518000, People's Republic of China
| | - Hang Jin
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Xin Sun
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Fuliang Zhang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Jing Qin
- Center for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, 999077, People's Republic of China
| | - Xiuli Yan
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Zhenyu Cai
- Department of Radiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China, 518000, People's Republic of China
| | - Ying Luo
- Department of Radiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China, 518000, People's Republic of China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Chang Chun, Jilin, 130021, People's Republic of China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, 518000, People's Republic of China.,Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, 518000, People's Republic of China
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Poli L, Leuci E, Costa P, De Giuli V, Caria F, Candeloro E, Persico A, Gamba M, Magoni M, Micieli G, Cavallini A, Padovani A, Pezzini A, Morotti A. Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion. Neurocrit Care 2021; 32:804-811. [PMID: 31342451 DOI: 10.1007/s12028-019-00797-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance. METHODS We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index. RESULTS A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76). CONCLUSIONS The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.
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Affiliation(s)
- Loris Poli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
| | - Eleonora Leuci
- Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Paolo Costa
- U.O. di Neurologia, Istituto Clinico Fondazione Poliambulanza, Brescia, Italy
| | - Valeria De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Filomena Caria
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Elisa Candeloro
- Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Alessandra Persico
- Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Neurologia Vascolare, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Giuseppe Micieli
- Dipartimento di Neurologia d'Urgenza, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Anna Cavallini
- Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Alessandro Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandro Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - Andrea Morotti
- Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
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3
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Cai J, Zhu H, Yang D, Yang R, Zhao X, Zhou J, Gao P. Accuracy of imaging markers on noncontrast computed tomography in predicting intracerebral hemorrhage expansion. Neurol Res 2020; 42:973-979. [PMID: 32693733 DOI: 10.1080/01616412.2020.1795577] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives Hematoma expansion (HE) is an important factor of unfavorable outcome in patients with intracerebral hemorrhage (ICH). Imaging markers on noncontrast computed tomography (NCCT) provide increasing value in the prediction of HE due to fast and easy-to-use advantages; however, the accuracy of NCCT-based prediction of intracerebral HE remains unclear. We aimed to investigate the predictive accuracy of NCCT markers for the evaluation of HE using a well-characterized ICH cohort. Methods We retrospectively analyzed 414 patients with spontaneous ICH, who underwent baseline CT within 6 h after symptom onset and follow-up CT within 24 h after ICH. Hematoma volumes were measured on baseline and follow-up CT images, and imaging features that predicted HE were analyzed. The test characteristics for the NCCT predictors were calculated. Results Of the 414 patients investigated, 63 presented blend sign, 45 showed black hole sign, 36 had island sign and 34 had swirl sign. In the 414 patients, 88 presented HE, the incidence was 21.26%. Of the 88 patients with HE, 22 presented blend sign, 11 showed black hole sign, 8 had swirl sign and 7 had island sign. The blend sign showed highest sensitivity (25.00%) and swirl sign showed the highest specificity (92.02%) among the four predictors. We noted excellent interobserver agreement for the identification of HE. Conclusion The four NCCT markers can predict HE with limited sensitivity, high specificity and good accuracy. This may be useful for prompt identification of patients at high risk of active bleeding, and prevention of over-treatment associated with HE. Abbreviations HE, hematoma expansion; ICH, intracerebral hemorrhage; NCCT, noncontrast computed tomography.
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Affiliation(s)
- Jinxiu Cai
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Huachen Zhu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Dan Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Rong Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Jian Zhou
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
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Barra ME, Das AS, Hayes BD, Rosenthal ES, Rosovsky RP, Fuh L, Patel AB, Goldstein JN, Roberts RJ. Evaluation of andexanet alfa and four-factor prothrombin complex concentrate (4F-PCC) for reversal of rivaroxaban- and apixaban-associated intracranial hemorrhages. J Thromb Haemost 2020; 18:1637-1647. [PMID: 32291874 DOI: 10.1111/jth.14838] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVE Before approval of andexanet alfa, off-label treatment with 4-factor prothrombin complex concentrate (4F-PCC) was often utilized for the management of life-threatening hemorrhages associated with oral factor Xa inhibitors. We evaluated the operational processes and outcomes of patients with oral factor Xa inhibitor-associated intracranial hemorrhages (ICH) treated with andexanet alfa or 4F-PCC. METHODS We performed a retrospective, single-center case series of rivaroxaban or apixaban-associated ICH between 2016-2019 treated with andexanet alfa or 4F-PCC. Good or excellent hemostatic effectiveness, good functional outcome (Glasgow Outcome Score [GOS]> 3) at hospital discharge, and incidence of thrombosis within 30 days were reported. RESULTS Eighteen patients were included in the andexanet alfa cohort and 11 in the 4F-PCC cohort. Excellent or good hemostasis occurred in 88.9% of andexanet alfa-treated patients and 60% of 4F-PCC-treated patients. Good functional outcome on discharge occurred in 55.6% of andexanet alfa-treated patients and 9.1% of 4F-PCC-treated patients. Thrombotic complications occurred in 16.7% of andexanet alfa-treated patients and 9.1% of 4F-PCC-treated patients. Median order-to-administration time was 1.1 hours [0.8-1.4] versus 0.5 hours [0.1-0.8] in the andexanet alfa and 4F-PCC group, respectively. The median cost of therapy was $29970/patient versus $6925/patient in the andexanet alfa and 4F-PCC group, respectively. CONCLUSIONS We observed higher rates of occurrence of good or excellent hemostasis and GOS > 3 on hospital discharge and increased incidence of thrombosis in patients who received andexanet alfa compared to 4F-PCC for oral factor Xa inhibitor reversal. However, patients receiving 4F-PCC had lower pre-reversal Glasgow Coma Scale (GCS)score and larger pre-reversal ICH volume.
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Affiliation(s)
- Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel P Rosovsky
- Department of Medicine, Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lanting Fuh
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
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5
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Morotti A, Boulouis G, Dowlatshahi D, Li Q, Barras CD, Delcourt C, Yu Z, Zheng J, Zhou Z, Aviv RI, Shoamanesh A, Sporns PB, Rosand J, Greenberg SM, Al-Shahi Salman R, Qureshi AI, Demchuk AM, Anderson CS, Goldstein JN, Charidimou A. Standards for Detecting, Interpreting, and Reporting Noncontrast Computed Tomographic Markers of Intracerebral Hemorrhage Expansion. Ann Neurol 2019; 86:480-492. [PMID: 31364773 DOI: 10.1002/ana.25563] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023]
Abstract
Significant hematoma expansion (HE) affects one-fifth of people within 24 hours after acute intracerebral hemorrhage (ICH), and its prevention is an appealing treatment target. Although the computed tomography (CT)-angiography spot sign predicts HE, only a minority of ICH patients receive contrast injection. Conversely, noncontrast CT (NCCT) is used to diagnose nearly all ICH, so NCCT markers represent a widely available alternative for prediction of HE. However, different NCCT signs describe similar features, with lack of consensus on the optimal image acquisition protocol, assessment, terminology, and diagnostic criteria. In this review, we propose practical guidelines for detecting, interpreting, and reporting NCCT predictors of HE. ANN NEUROL 2019;86:480-492.
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Affiliation(s)
- Andrea Morotti
- Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Pavia, Italy
| | - Gregoire Boulouis
- Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Neuroradiology, Centre Hospitalier Sainte Anne, Paris, France
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Qi Li
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Christen D Barras
- South Australian Health and Medical Research Institute and Department of Radiology, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Candice Delcourt
- Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, University of Sydney, Sydney, New South Wales, Australia.,George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhiyuan Yu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zien Zhou
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Richard I Aviv
- Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada
| | - Peter B Sporns
- Institute of Clinical Radiology, University of Münster, Münster, Germany
| | - Jonathan Rosand
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA
| | - Steven M Greenberg
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Andrew M Demchuk
- Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Craig S Anderson
- Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, University of Sydney, Sydney, New South Wales, Australia.,George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Joshua N Goldstein
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andreas Charidimou
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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