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Schreiber F, Kuschel JN, Klai M, Chahem C, Arndt P, Perosa V, Assmann A, Dörner M, Luchtmann M, Meuth SG, Vielhaber S, Henneicke S, Schreiber S. Blend Sign and Haemorrhage Location and Volume Predict Late Recurrence and Mortality in Intracerebral Haemorrhage Patients. J Clin Med 2023; 12:6131. [PMID: 37834774 PMCID: PMC10573360 DOI: 10.3390/jcm12196131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Studies on risk factors for primary intracerebral haemorrhage (ICH) focus on short-term predictive values of distinct clinical parameters or computed tomography (CT) markers and disregard the others. We, therefore, studied independent predictive values of demographic, clinical, and CT markers regarding ICH expansion, late ICH recurrence, and late mortality. METHODS In a retrospective study of 288 patients with primary ICH, ICH localization (158 lobar, 81 deep, and 49 cerebellar), volume, blend sign, spot sign, finger-like projections, and subarachnoid haemorrhages were evaluated. ICH localization-specific differences for demographic (age, sex), clinical parameters (vascular risk factors, antiplatelet, and anticoagulation therapy), and CT markers were evaluated using logistic regression. We applied Cox proportional hazards modelling using these parameters to predict risk factors for ICH expansion, late ICH recurrence, and late mortality. RESULTS The blend sign in lobar ICH relates to increased risk of ICH expansion (HR2.3), late ICH recurrence (HR2.3), and mortality (HR1.6). Age, conditions requiring antiplatelet medication, deep ICH localization, volume, and blend sign represented the most important independent factors impacting overall mortality. CONCLUSIONS Blend sign at baseline ICH is a manifestation of underlying detrimental vascular processes that signal increased ICH expansion risk, although is also indicative of long-term risks for late recurrent ICH and late mortality.
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Affiliation(s)
- Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany;
| | - Jan-Niklas Kuschel
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
| | - Marwa Klai
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
| | - Christian Chahem
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
| | - Philipp Arndt
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany;
| | - Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
| | - Marc Dörner
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany;
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Michael Luchtmann
- Department of Neurosurgery, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Sven Günther Meuth
- Department of Neurology, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke University, 39106 Magdeburg, Germany
| | - Solveig Henneicke
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany;
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (F.S.); (J.-N.K.); (M.K.); (C.C.); (P.A.); (V.P.); (S.V.); (S.H.)
- German Center for Neurodegenerative Diseases (DZNE), 39120 Magdeburg, Germany;
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke University, 39106 Magdeburg, Germany
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Rodriguez-Luna D, Pancorbo O, Coscojuela P, Lozano P, Rizzo F, Olivé-Gadea M, Requena M, García-Tornel Á, Rodríguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Molina CA. Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities. Eur Radiol 2023; 33:6045-6053. [PMID: 37059906 DOI: 10.1007/s00330-023-09621-0] [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: 11/09/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. METHODS After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. RESULTS The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58-0.80) and 0.59 (0.46-0.72) for NCCT score, significantly lower than 0.75 ([0.64-0.87], p = 0.038) and 0.72 ([0.59-0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68-0.89], p = 0.033) and 0.73 ([0.62-0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively. CONCLUSION This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. KEY POINTS • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.
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Affiliation(s)
- David Rodriguez-Luna
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain.
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.
| | - Olalla Pancorbo
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Prudencio Lozano
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Federica Rizzo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Olivé-Gadea
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Álvaro García-Tornel
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Noelia Rodríguez-Villatoro
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jesús M Juega
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sandra Boned
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marián Muchada
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jorge Pagola
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Rubiera
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos A Molina
- Department of Neurology, Vall d'Hebron University Hospital, Ps Vall d'Hebron 119, 08035, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Sengupta J, Alzbutas R, Falkowski-Gilski P, Falkowska-Gilska B. Intracranial hemorrhage detection in 3D computed tomography images using a bi-directional long short-term memory network-based modified genetic algorithm. Front Neurosci 2023; 17:1200630. [PMID: 37469843 PMCID: PMC10352619 DOI: 10.3389/fnins.2023.1200630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Intracranial hemorrhage detection in 3D Computed Tomography (CT) brain images has gained more attention in the research community. The major issue to deal with the 3D CT brain images is scarce and hard to obtain the labelled data with better recognition results. Methods To overcome the aforementioned problem, a new model has been implemented in this research manuscript. After acquiring the images from the Radiological Society of North America (RSNA) 2019 database, the region of interest (RoI) was segmented by employing Otsu's thresholding method. Then, feature extraction was performed utilizing Tamura features: directionality, contrast, coarseness, and Gradient Local Ternary Pattern (GLTP) descriptors to extract vectors from the segmented RoI regions. The extracted vectors were dimensionally reduced by proposing a modified genetic algorithm, where the infinite feature selection technique was incorporated with the conventional genetic algorithm to further reduce the redundancy within the regularized vectors. The selected optimal vectors were finally fed to the Bi-directional Long Short Term Memory (Bi-LSTM) network to classify intracranial hemorrhage sub-types, such as subdural, intraparenchymal, subarachnoid, epidural, and intraventricular. Results The experimental investigation demonstrated that the Bi-LSTM based modified genetic algorithm obtained 99.40% sensitivity, 99.80% accuracy, and 99.48% specificity, which are higher compared to the existing machine learning models: Naïve Bayes, Random Forest, Support Vector Machine (SVM), Recurrent Neural Network (RNN), and Long Short-Term Memory (LSTM) network.
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Romero JM, Rojas-Serrano LF. Current Evaluation of Intracerebral Hemorrhage. Radiol Clin North Am 2023; 61:479-490. [PMID: 36931764 DOI: 10.1016/j.rcl.2023.01.005] [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] [Indexed: 02/22/2023]
Abstract
Advanced imaging is currently critical in diagnosing, predicting, and managing intracerebral hemorrhage. MD CT angiography has occupied the first line of evaluating patients with a clinical diagnosis of a stroke, given its rapid acquisition time, high resolution of vascular structures, and sensitivity for secondary causes of ICH.
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Affiliation(s)
- Javier M Romero
- Radiology Department, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray Building, 241G, MA 02114, USA.
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Huang YW, Huang HL, Li ZP, Yin XS. Research advances in imaging markers for predicting hematoma expansion in intracerebral hemorrhage: a narrative review. Front Neurol 2023; 14:1176390. [PMID: 37181553 PMCID: PMC10166819 DOI: 10.3389/fneur.2023.1176390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Stroke is a major global health concern and is ranked as the second leading cause of death worldwide, with the third highest incidence of disability. Intracerebral hemorrhage (ICH) is a devastating form of stroke that is responsible for a significant proportion of stroke-related morbidity and mortality worldwide. Hematoma expansion (HE), which occurs in up to one-third of ICH patients, is a strong predictor of poor prognosis and can be potentially preventable if high-risk patients are identified early. In this review, we provide a comprehensive summary of previous research in this area and highlight the potential use of imaging markers for future research studies. Recent advances Imaging markers have been developed in recent years to aid in the early detection of HE and guide clinical decision-making. These markers have been found to be effective in predicting HE in ICH patients and include specific manifestations on Computed Tomography (CT) and CT Angiography (CTA), such as the spot sign, leakage sign, spot-tail sign, island sign, satellite sign, iodine sign, blend sign, swirl sign, black hole sign, and hypodensities. The use of imaging markers holds great promise for improving the management and outcomes of ICH patients. Conclusion The management of ICH presents a significant challenge, and identifying high-risk patients for HE is crucial to improving outcomes. The use of imaging markers for HE prediction can aid in the rapid identification of such patients and may serve as potential targets for anti-HE therapies in the acute phase of ICH. Therefore, further research is needed to establish the reliability and validity of these markers in identifying high-risk patients and guiding appropriate treatment decisions.
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Affiliation(s)
- Yong-Wei Huang
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Hai-Lin Huang
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Zong-Ping Li
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Xiao-Shuang Yin
- Department of Immunology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
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Morotti A, Boulouis G, Nawabi J, Li Q, Charidimou A, Pasi M, Schlunk F, Shoamanesh A, Katsanos AH, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Warren AD, Laudisi M, Cavallini A, Gurol EM, Viswanathan A, Zini A, Casetta I, Fainardi E, Greenberg SM, Padovani A, Rosand J, Goldstein JN. Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion. Stroke 2023; 54:567-574. [PMID: 36621819 PMCID: PMC10037534 DOI: 10.1161/strokeaha.122.041302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign. METHODS Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994-2015, prospective), Hamilton, Canada (2010-2016, retrospective), Berlin, Germany (2014-2019, retrospective), Chongqing, China (2011-2015, retrospective), Pavia, Italy (2017-2019, prospective), Ferrara, Italy (2010-2019, retrospective), Brescia, Italy (2020-2021, retrospective), and Bologna, Italy (2015-2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison. RESULTS A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55-3.80]; P<0.001). The inclusion of noncontrast computed tomography hypodensities improved the discrimination of the 4 predictors model (area under the curve, 0.67 [95% CI, 0.64-0.69] versus 0.71 [95% CI, 0.69-0.74]; P=0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64-0.73] versus 0.74 [95% CI, 0.70-0.78]; P=0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70-0.78]). CONCLUSIONS Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Gregoire Boulouis
- Neuroradiology Department, University Hospital of Tours, CEDEX 09, 37044 Tours, France
| | - Jawed Nawabi
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Qi Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Andreas Charidimou
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Pasi
- Neurology department, University Hospital of Tours, CEDEX 09, 37044 Tours, France
| | - Frieder Schlunk
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
- Department of Neuroradiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Federico Mazzacane
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italia
| | - Giorgio Busto
- Department of Biomedical Experimental and Clinical, Neuroradiology, University of Firenze, AOU Careggi, Firenze, Italy
| | | | - Laura Brancaleoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna,UOC Neurologia e Rete Stroke Metropolitana,Ospedale Maggiore, Bologna, Italia
| | - Sebastiano Giacomozzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna,UOC Neurologia e Rete Stroke Metropolitana,Ospedale Maggiore, Bologna, Italia
| | - Luigi Simonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità di Neuroradiologia, Ospedale Maggiore, Bologna, Italia
| | - Andrew D. Warren
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michele Laudisi
- Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna,Ferrara, Italia
| | - Anna Cavallini
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italia
| | - Edip M Gurol
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna,UOC Neurologia e Rete Stroke Metropolitana,Ospedale Maggiore, Bologna, Italia
| | - Ilaria Casetta
- Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna,Ferrara, Italia
| | - Enrico Fainardi
- Department of Biomedical Experimental and Clinical, Neuroradiology, University of Firenze, AOU Careggi, Firenze, Italy
| | - Steven M. Greenberg
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy
| | - Jonathan Rosand
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N. Goldstein
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Morotti A, Busto G, Boulouis G, Scola E, Padovani A, Casetta I, Fainardi E. Added value of non-contrast CT and CT perfusion markers for prediction of intracerebral hemorrhage expansion and outcome. Eur Radiol 2023; 33:690-698. [PMID: 35895123 DOI: 10.1007/s00330-022-08987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To test the hypothesis that the combined analysis of non-contrast CT (NCCT) and CT perfusion (CTP) imaging markers improves prediction of hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH). METHODS Retrospective, single-center analysis of patients with primary ICH undergoing NCCT and CTP within 6 h from onset. NCCT images were assessed for the presence of intrahematomal hypodensity and shape irregularity. Perihematomal cerebral blood volume and spot sign were assessed on CTP. The main outcomes of the analysis were HE (growth > 6 mL and/or > 33%) and poor functional prognosis (90 days modified Rankin Scale 3-6). Predictors of HE and outcome were explored with logistic regression. RESULTS A total of 150 subjects were included (median age 68, 47.1% males) of whom 54 (36%) had HE and 52 (34.7%) had poor outcome. The number of imaging markers on baseline imaging was independently associated with HE (odds ratio 2.66, 95% confidence interval 1.70-4.17, p < 0.001) and outcome (odds ratio 1.64, 95% CI 1.06-2.56, p = 0.027). Patients with the simultaneous presence of all the four markers had the highest risk of HE and unfavorable prognosis (mean predicted probability of 91% and 79% respectively). The combined-markers analysis outperformed the sensitivity of the single markers analyzed separately. In particular, the presence of at least one marker identified patients with HE and poor outcome with 91% and 87% sensitivity respectively. CONCLUSION NCCT and CTP markers provide additional yield in the prediction of HE and ICH outcome. KEY POINTS • Perihematomal hypoperfusion is associated with hematoma expansion and poor outcome in acute intracerebral hemorrhage. • Non-contrast CT and CT perfusion markers improve prediction of hematoma expansion and unfavorable prognosis. • A multimodal CT protocol including CT perfusion will help the identification of patients at high risk of clinical deterioration and poor outcome.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, P.le Spedali Civili 1, 25100, Brescia, Italy.
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Tours, Centre Val de Loire Region, France
| | - Elisa Scola
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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8
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Chung GH, Goo JH, Kwak HS, Hwang SB. The comprehensive comparison of imaging sign from CT angiography and noncontrast CT for predicting intracranial hemorrhage expansion: A comparative study. Medicine (Baltimore) 2022; 101:e31914. [PMID: 36626412 PMCID: PMC9750542 DOI: 10.1097/md.0000000000031914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Expansion of intracranial hemorrhage (ICH) is an important predictor of poor clinical outcomes. Various imaging markers on non-contrast computed tomography (NCCT) or computed tomographic angiography (CTA) have been reported as predictors of ICH expansion. We aimed to compare the associations between various CT imaging markers and ICH expansion. Patients with spontaneous ICH who underwent initial NCCT, CTA, and subsequent NCCT between January 2016 and December 2019 were retrospectively identified. ICH expansion was defined as a volume increase of > 33% or > 6 mL. We analyzed the presence of imaging markers such as the black hole sign, blend sign, island sign, or swirl sign on initial NCCT or spot sign on CTA. An alternative free-response receiver operating characteristic curve analysis was performed using a 4-point scoring system based on the consensus of the reviewers. The predictive value of each marker was assessed using univariate and multivariate logistic regression analyses. A total of 250 patients, including 60 (24.0%) with ICH expansion, qualified for the analysis. Among the patients with spontaneous ICH, 118 (47.2%) presented with a black hole sign, 52 (20.8%) with a blend sign, 93 (37.2%) with an island sign, 79 (31.6%) with a swirl sign, and 56 (22.4%) with a spot sign. In univariate logistic regression, the initial ICH volume (P = .038), initial intraventricular hemorrhage (IVH) presence (P < .001), swirl sign (P < .001), and spot sign (P < .001) were associated with ICH expansion. Multivariate analysis confirmed that the presence of initial IVH (odds ratio, 4.111; P = .002) and spot sign (odds ratio, 109.5; P < .001) were independent predictors of ICH expansion. Initial ICH volume, IVH, swirl sign, and spot sign are associated with ICH expansion. The presence of spot signs and IVH were independent predictors of ICH expansion.
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Affiliation(s)
- Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeollabuk-do, Korea
| | - Ja Hong Goo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Jeollabuk-do, Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeollabuk-do, Korea
- *Correspondence: Hyo Sung Kwak, Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 567 Baekje-daero, deokjin-gu, Jeonju-si, Jeollabuk-do, 561-756, Republic of Korea (e-mail: )
| | - Seung Bae Hwang
- Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeollabuk-do, Korea
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9
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Warren AD, Li Q, Schwab K, McKaig B, Goldstein AN, Greenberg SM, Viswanathan A, Anderson C, Gurol ME, Patel A, Goldstein JN. External ventricular drain placement is associated with lower mortality after intracerebral hemorrhage with intraventricular hemorrhage. Int J Emerg Med 2022; 15:51. [PMID: 36109697 PMCID: PMC9479417 DOI: 10.1186/s12245-022-00450-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and aims
Many patients with intracerebral hemorrhage (ICH) develop intraventricular hemorrhage (IVH), which is associated with higher mortality and worse clinical outcome. External ventricular drains (EVDs) are often placed, but there is little data on how much patients benefit from this intervention. We explored the use, timing, and location of EVD in ICH patients and any association with clinical outcome.
Results
During the study period, 2870 patients presented with primary ICH, and 2486 were included in analyses. Overall, patients were 73 (± 13) years old; 54% were male, and 46% had associated IVH. An EVD was placed in 29% of patients with IVH and 4% of those without. IVH patients with EVD were younger (67 ± 13 vs 74 ± 13, p < 0.001), had larger IVH volumes (17 mL vs 8 mL, p < 0.001), and lower GCS scores (7 vs 10, p < 0.001), compared to those without EVD. Ninety-day mortality was available in 2486 (100%) patients, while 90-day mRS was available in 1673 (67.3%). In univariate analysis, EVD placement was associated with lower likelihood of 90-day mortality (53% vs 59%, p = 0.048) but higher likelihood of poor outcome (88% vs 85%, p < 0.001) in those for whom this was available. Those with poor outcomes underwent faster EVD placement (0.46 days vs. 0.96 days, p = 0.01). In multivariate analysis, EVD placement was associated with lower 90-day mortality (OR 0.19, 95% CI 0.053–0.657, p = 0.009), but not with lower odds of poor outcome (OR 1.64, 95% CI 0.508–5.309, p = 0.4). In multivariate analysis, days to EVD placement was associated with lower 90-day mortality (OR 0.69, 95% CI 0.49–0.96, p = 0.027).
Conclusion
IVH is relatively common after ICH. After controlling for potential confounds, EVD placement is associated with lower mortality, but not clearly with better neurologic outcome. In addition, more rapid EVD placement is associated with higher mortality, potentially reflecting early development of herniation or obstructive hydrocephalus.
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10
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Wu TC, Liu YL, Chen JH, Zhang Y, Chen TY, Ko CC, Su MY. The Added Value of Intraventricular Hemorrhage on the Radiomics Analysis for the Prediction of Hematoma Expansion of Spontaneous Intracerebral Hemorrhage. Diagnostics (Basel) 2022; 12:diagnostics12112755. [PMID: 36428815 PMCID: PMC9689620 DOI: 10.3390/diagnostics12112755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Among patients undergoing head computed tomography (CT) scans within 3 h of spontaneous intracerebral hemorrhage (sICH), 28% to 38% have hematoma expansion (HE) on follow-up CT. This study aimed to predict HE using radiomics analysis and investigate the impact of intraventricular hemorrhage (IVH) compared with the conventional approach based on intraparenchymal hemorrhage (IPH) alone. Methods: This retrospective study enrolled 127 patients with baseline and follow-up non-contrast CT (NCCT) within 4~72 h of sICH. IPH and IVH were outlined separately for performing radiomics analysis. HE was defined as an absolute hematoma growth > 6 mL or percentage growth > 33% of either IPH (HEP) or a combination of IPH and IVH (HEP+V) at follow-up. Radiomic features were extracted using PyRadiomics, and then the support vector machine (SVM) was used to build the classification model. For each case, a radiomics score was generated to indicate the probability of HE. Results: There were 57 (44.9%) HEP and 70 (55.1%) non-HEP based on IPH alone, and 58 (45.7%) HEP+V and 69 (54.3%) non-HEP+V based on IPH + IVH. The majority (>94%) of HE patients had poor early outcomes (death or modified Rankin Scale > 3 at discharge). The radiomics model built using baseline IPH to predict HEP (RMP) showed 76.4% accuracy and 0.73 area under the ROC curve (AUC). The other model using IPH + IVH to predict HEP+V (RMP+V) had higher accuracy (81.9%) with AUC = 0.80, and this model could predict poor outcomes. The sensitivity/specificity of RMP and RMP+V for HE prediction were 71.9%/80.0% and 79.3%/84.1%, respectively. Conclusion: The proposed radiomics approach with additional IVH information can improve the accuracy in prediction of HE, which is associated with poor clinical outcomes. A reliable radiomics model may provide a robust tool to help manage ICH patients and to enroll high-risk ICH cases into anti-expansion or neuroprotection drug trials.
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Affiliation(s)
- Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Department of Medical Sciences Industry, Chang Jung Christian University, Tainan 71101, Taiwan
- Correspondence: (T.-C.W.); (J.-H.C.); Tel.: +886-62812811 (ext. 53752) (T.-C.W.)
| | - Yan-Lin Liu
- Department of Radiological Sciences, University of California, Irvine, CA 92521, USA
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA 92521, USA
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung 84001, Taiwan
- Correspondence: (T.-C.W.); (J.-H.C.); Tel.: +886-62812811 (ext. 53752) (T.-C.W.)
| | - Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA 92521, USA
- Department of Radiation Oncology, Rutgers-Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan 71004, Taiwan
- Center of General Education, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA 92521, USA
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11
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Truong MQ, Metcalfe AV, Ovenden CD, Kleinig TJ, Barras CD. Intracerebral hemorrhage markers on non-contrast computed tomography as predictors of the dynamic spot sign on CT perfusion and associations with hematoma expansion and outcome. Neuroradiology 2022; 64:2135-2144. [PMID: 36076088 DOI: 10.1007/s00234-022-03032-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the association between non-contrast computed tomography (NCCT) hematoma markers and the dynamic spot sign on computed tomography perfusion (CTP), and their associations with hematoma expansion, clinical outcome, and in-hospital mortality. METHODS Patients who presented with intracerebral hemorrhage (ICH) to a stroke center over an 18-month period and underwent baseline NCCT and CTP, and a follow-up NCCT within 24 h after the baseline scan were included. The initial and follow-up hematoma volumes were calculated. Two raters independently assessed the baseline NCCT for hematoma markers and concurrently assessed the CTP for the dynamic spot sign. Univariate and multivariate logistic regression analyses were performed to assess the association between the hematoma markers and the dynamic spot sign, adjusting for known ICH expansion predictors. RESULTS Eighty-five patients were included in our study and 55 patients were suitable for expansion analysis. Heterogeneous density was the only NCCT hematoma marker to be associated with the dynamic spot sign after multivariate analysis (odds ratio, 58.61; 95% confidence interval, 9.13-376.05; P < 0.001). The dynamic spot sign was present in 22 patients (26%) and significantly predicted hematoma expansion (odds ratio, 36.6; 95% confidence interval, 2.51-534.2; P = 0.008). All patients with a spot sign had a swirl sign. A co-located hypodensity and spot sign was significantly associated with in-hospital mortality (odds ratio, 6.17; 95% confidence interval, 1.09-34.78; P = 0.039). CONCLUSION Heterogeneous density and swirl sign are associated with the dynamic spot sign. The dynamic spot sign is a stronger predictor than NCCT hematoma markers of significant hematoma expansion. A co-located spot sign and hypodensity predicts in-hospital mortality.
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Affiliation(s)
| | - Andrew Viggo Metcalfe
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher Dillon Ovenden
- Faculty of Health and Medical Sciences, Surgical Specialties, The University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy John Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christen David Barras
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
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12
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Nehme A, Ducroux C, Panzini MA, Bard C, Bereznyakova O, Boisseau W, Deschaintre Y, Diestro JDB, Guilbert F, Jacquin G, Maallah MT, Nelson K, Padilha IG, Poppe AY, Rioux B, Roy D, Touma L, Weill A, Gioia LC, Létourneau-Guillon L. Non-contrast CT markers of intracerebral hematoma expansion: a reliability study. Eur Radiol 2022; 32:6126-6135. [PMID: 35348859 DOI: 10.1007/s00330-022-08710-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We evaluated whether clinicians agree in the detection of non-contrast CT markers of intracerebral hemorrhage (ICH) expansion. METHODS From our local dataset, we randomly sampled 60 patients diagnosed with spontaneous ICH. Fifteen physicians and trainees (Stroke Neurology, Interventional and Diagnostic Neuroradiology) were trained to identify six density (Barras density, black hole, blend, hypodensity, fluid level, swirl) and three shape (Barras shape, island, satellite) expansion markers, using standardized definitions. Thirteen raters performed a second assessment. Inter- and intra-rater agreement were measured using Gwet's AC1, with a coefficient > 0.60 indicating substantial to almost perfect agreement. RESULTS Almost perfect inter-rater agreement was observed for the swirl (0.85, 95% CI: 0.78-0.90) and fluid level (0.84, 95% CI: 0.76-0.90) markers, while the hypodensity (0.67, 95% CI: 0.56-0.76) and blend (0.62, 95% CI: 0.51-0.71) markers showed substantial agreement. Inter-rater agreement was otherwise moderate, and comparable between density and shape markers. Inter-rater agreement was lower for the three markers that require the rater to identify one specific axial slice (Barras density, Barras shape, island: 0.46, 95% CI: 0.40-0.52 versus others: 0.60, 95% CI: 0.56-0.63). Inter-observer agreement did not differ when stratified for raters' experience, hematoma location, volume, or anticoagulation status. Intra-rater agreement was substantial to almost perfect for all but the black hole marker. CONCLUSION In a large sample of raters with different backgrounds and expertise levels, only four of nine non-contrast CT markers of ICH expansion showed substantial to almost perfect inter-rater agreement. KEY POINTS • In a sample of 15 raters and 60 patients, only four of nine non-contrast CT markers of ICH expansion showed substantial to almost perfect inter-rater agreement (Gwet's AC1> 0.60). • Intra-rater agreement was substantial to almost perfect for eight of nine hematoma expansion markers. • Only the blend, fluid level, and swirl markers achieved substantial to almost perfect agreement across all three measures of reliability (inter-rater agreement, intra-rater agreement, agreement with the results of a reference reading).
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Affiliation(s)
- Ahmad Nehme
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
| | - Célina Ducroux
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Marie-Andrée Panzini
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Céline Bard
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Olena Bereznyakova
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - William Boisseau
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Yan Deschaintre
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | | | - François Guilbert
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Grégory Jacquin
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Taoubane Maallah
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Kristoff Nelson
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Igor Gomes Padilha
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alexandre Y Poppe
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Bastien Rioux
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Daniel Roy
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Lahoud Touma
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alain Weill
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Laura C Gioia
- Neurovascular Health Program, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Axe Neurosciences, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
- Département de Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Laurent Létourneau-Guillon
- Département de Radiologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
- Imaging and Engineering Axis, Centre de Recherche du CHUM (CRCHUM), Montréal, Québec, Canada
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13
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Machine learning prediction of hematoma expansion in acute intracerebral hemorrhage. Sci Rep 2022; 12:12452. [PMID: 35864139 PMCID: PMC9304401 DOI: 10.1038/s41598-022-15400-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/23/2022] [Indexed: 12/28/2022] Open
Abstract
To examine whether machine learning (ML) approach can be used to predict hematoma expansion in acute intracerebral hemorrhage (ICH) with accuracy and widespread applicability, we applied ML algorithms to multicenter clinical data and CT findings on admission. Patients with acute ICH from three hospitals (n = 351) and those from another hospital (n = 71) were retrospectively assigned to the development and validation cohorts, respectively. To develop ML predictive models, the k-nearest neighbors (k-NN) algorithm, logistic regression, support vector machines (SVMs), random forests, and XGBoost were applied to the patient data in the development cohort. The models were evaluated for their performance on the patient data in the validation cohort, which was compared with previous scoring methods, the BAT, BRAIN, and 9-point scores. The k-NN algorithm achieved the highest area under the receiver operating characteristic curve (AUC) of 0.790 among all ML models, and the sensitivity, specificity, and accuracy were 0.846, 0.733, and 0.775, respectively. The BRAIN score achieved the highest AUC of 0.676 among all previous scoring methods, which was lower than the k-NN algorithm (p = 0.016). We developed and validated ML predictive models of hematoma expansion in acute ICH. The models demonstrated good predictive ability, showing better performance than the previous scoring methods.
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14
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Masotti L, Grifoni E, Migli L, Dei A, Spina R, Calamai I, Guazzini G, Micheletti I, Cosentino E, Pinto G, Vanni S. Prognostic determinants in patients with non traumatic intracerebral hemorrhage: a real life report. Acta Clin Belg 2021; 76:365-372. [PMID: 32279610 DOI: 10.1080/17843286.2020.1750151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and aim: Nontraumatic intracerebral hemorrhage (ICH) remains a devastating disease for high in-hospital and long-term mortality and residual neurological disability. The aim of our study was to analyze the prognostic factors in patients managed for ICH in the real-life clinical practice.Materials and Methods: We retrospectively analyzed clinical and neuro-radiological data of consecutive patients admitted to our Hospital for ICH along 1 year. In-hospital mortality and 90-day modified Rankin scale (mRS) ≥4 were the study outcomes. Moreover, we compared patients admitted in Intensive Care Unit (ICU) with patients admitted in Stroke Unit (SU).Results: Ninety-eight patients with mean age ± SD 78 ± 12 years were enrolled. In-hospital and 90-day mortality were 36.7% and 41.8%, respectively. Patients who died had a significantly higher percentage of ICH volume >30 mL, irregular shape, lobar location, intraventricular hemorrhage (IVH), midline shift, hydrocephalus, hematoma enlargement, Glasgow Coma Scale (GCS) ≤9 at hospital admission, early neurological worsening (ENW), higher Hemphill ICH score, and underwent oro-tracheal intubation more frequently compared with patients who survived. Patients admitted to ICU were younger and significantly more critical compared with those who were admitted to SU. In-hospital mortality in patients admitted to ICU was 52.6% compared with 25% in patients admitted to SU (p < 0.01). Median mRS score at hospital discharge was 4 (IQR 3-5) and at 90 days was 4 (IQR 3-4). ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were found independent risk factors for in-hospital mortality, while age was found as independent risk factor for 90-day mRS ≥4).Conclusion: In real life, prognosis of ICH is associated with clinical and radiological determinants. In our study ENW, hematoma enlargement, Hemphill ICH score ≥3 and midline shift >10 mm were associated with short-term mortality risk, while age with 90-day mRS ≥4.
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Affiliation(s)
- Luca Masotti
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | - Elisa Grifoni
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | - Lavinia Migli
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | - Alessandro Dei
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | - Rosario Spina
- Intensive Care Unit, San Giuseppe Hospital, Empoli, Italy
| | - Italo Calamai
- Intensive Care Unit, San Giuseppe Hospital, Empoli, Italy
| | | | | | | | - Gabriele Pinto
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | - Simone Vanni
- Emergency Department, San Giuseppe Hospital, Empoli, Italy
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15
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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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Lv XN, Deng L, Yang WS, Wei X, Li Q. Computed Tomography Imaging Predictors of Intracerebral Hemorrhage Expansion. Curr Neurol Neurosci Rep 2021; 21:22. [PMID: 33710468 DOI: 10.1007/s11910-021-01108-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Hematoma expansion (HE) is strongly associated with poor clinical outcome and is a compelling target for improving outcome after intracerebral hemorrhage (ICH). Non-contrast computed tomography (NCCT) is widely used in clinical practice due to its faster acquisition at the presence of acute stroke. Recently, imaging markers on NCCT are increasingly used for predicting HE. We comprehensively review the current evidence on HE prediction using NCCT and provide a summary for assessment of these markers in future research studies. RECENT FINDINGS Predictors of HE on NCCT have been described in reports of several studies. The proposed markers, including swirl sign, blend sign, black hole sign, island sign, satellite sign, and subarachnoid extension, were all significantly associated with HE and poor outcome in their small sample studies after ICH. In summary, the optimal management of ICH remains a therapeutic dilemma. Therefore, using NCCT markers to select patients at high risk of HE is urgently needed. These markers may allow rapid identification and provide potential targets for anti-HE treatments in patients with acute ICH.
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Affiliation(s)
- Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao Wei
- Department of Traditional Chinese Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China.
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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17
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Neuroimaging of Acute Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10051086. [PMID: 33807843 PMCID: PMC7962049 DOI: 10.3390/jcm10051086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 01/25/2023] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.
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Su CM, Warren A, Kraus C, Macias-Konstantopoulos W, Zachrison KS, Viswanathan A, Anderson C, Gurol ME, Greenberg SM, Goldstein JN. Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage. Int J Emerg Med 2021; 14:6. [PMID: 33468042 PMCID: PMC7814635 DOI: 10.1186/s12245-021-00329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background and aim Early diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. We examined whether racial or ethnic disparities exist in acute care processes in the first hours after ICH. Methods We performed a retrospective review of a prospectively collected cohort of consecutive patients with spontaneous primary ICH presenting to a single urban tertiary care center. Acute care processes studied included time to computerized tomography (CT) scan, time from CT to inpatient bed request, and time from bed request to hospital admission. Clinical outcomes included mortality, Glasgow Outcome Scale, and modified Rankin Scale. Results Four hundred fifty-nine patients presented with ICH between 2006 and 2018 and met inclusion criteria (55% male; 75% non-Hispanic White [NHW]; mean age of 73). In minutes, median time to CT was 43 (interquartile range [IQR] 28, 83), time to bed request was 62 (IQR 33, 114), and time to admission was 142 (IQR 95, 232). In a multivariable analysis controlling for demographic factors, clinical factors, and disease severity, race/ethnicity had no effect on acute care processes. English language, however, was independently associated with slower times to CT (β = 30.7 min, 95% CI 9.9 to 51.4, p = 0.004) and to bed request (β = 32.8 min, 95% CI 5.5 to 60.0, p = 0.02). Race/ethnicity and English language were not independently associated with worse outcome. Conclusions We found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
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Affiliation(s)
- Chun Mei Su
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Andrew Warren
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Cassie Kraus
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Wendy Macias-Konstantopoulos
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Christopher Anderson
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA.
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Shi Y, Fan X, Li G, Zhong D, Zhang X. Association of Serum Dystroglycan, MMP-2/9 and AQP-4 with Haematoma Expansion in Patients with Intracerebral Haemorrhage. Neuropsychiatr Dis Treat 2021; 17:11-18. [PMID: 33442252 PMCID: PMC7797333 DOI: 10.2147/ndt.s283016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/23/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore association of serum dystroglycan (DG), matrix metalloproteinase-2/matrix metalloproteinase-9 (MMP-2/9), and aquaporin-4 (AQP-4) expression and haematoma expansion in patients with intracerebral haemorrhage (ICH), which are proteins involved in maintaining the integrity of the blood-brain barrier. METHODS We included patients older than 18 years old with ICH who had undergone baseline CT within 6 hours after intracerebral haemorrhage symptom onset in our hospital between April 2018 and December 2018. Two readers independently assessed haematoma volume and other imaging information upon admission and again within 24 hours. All patients underwent 5 mL of venous blood collection 6 and 24 hours after admission. Serum expression levels of dystroglycan, matrix metalloproteinase-2/matrix metalloproteinase-9 and aquaporin-4 were determined by quantitative enzyme-linked immunosorbent assay (ELISA). Repeated analysis of variance was used to determine whether expression of the four proteins in patients with cerebral haemorrhage changed within 24 hours and whether there were differences between the haematoma enlargement and non-haematoma enlargement groups over time. Univariate and multivariate logistic regression analyses were used to compare the correlation among expression of the four proteins, clinical characteristics of patients and haematoma enlargement. RESULTS Expression levels of serum matrix metalloproteinase-2/matrix metalloproteinases-9 and aquaporin-4 gradually increased within 24 hours in patients with cerebral haemorrhage (P<0.001), while expression levels of dystroglycan gradually decreased (P<0.01). Expression of serum matrix metalloproteinases-9 6 hours after onset was independently correlated with the expansion of cerebral haemorrhage. The ROC curve (AUC=0.778, 95% Cl: 0.661-0.894, P<0.001) exhibited high sensitivity (0.900) and low specificity (0.642). CONCLUSION These data support that expression of MMP-9 in peripheral blood is independently correlated with the enlargement of haematoma in patients with intracerebral haemorrhage 6 hours after onset and can be used as an independent predictor of haematoma enlargement in patients with intracerebral haemorrhage. However, although the expression of MMP-2, AQP-4 and DG exhibited some changes within 6 and 24 hours after onset, they were not independently correlated with early haematoma enlargement in patients with intracerebral haemorrhage. Further multi-time point exploration and expansion of the sample size is necessary in future studies.
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Affiliation(s)
- Yue Shi
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Xuehui Fan
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Guozhong Li
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Di Zhong
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, People's Republic of China
| | - Xin Zhang
- Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, 545006, People's Republic of China
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20
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Wei H, Feng H, Lv M, Zhong Y, Yang X, Zhou X, Lei Z, Xia J. Smoking Status Affects the Association Between Hematoma Heterogeneity and Hematoma Expansion. World Neurosurg X 2020; 9:100095. [PMID: 33225256 PMCID: PMC7666337 DOI: 10.1016/j.wnsx.2020.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/03/2020] [Indexed: 11/26/2022] Open
Abstract
Objective The purpose of this study was to verify the relationship between hematoma heterogeneity and hematoma expansion and explore any effect modifiers through subgroup analyses. Methods Clinical records of 357 patients with spontaneous cerebral hemorrhage at Shenzhen Second People’s Hospital from March 2016 to October 2018 were included in the study. Hematoma heterogeneity was measured on the first noncontrast computed tomography image according to the Barras scale. Hematoma expansion was defined as an absolute hematoma volume increase of 6 mL, or a 33% increase. We performed univariate and multivariate logistic regression analyses, as well as subgroup analyses, to assess the relationship between the presence of heterogeneity on noncontrast computed tomography and hematoma expansion. Results Hematoma expansion occurred in 79 (22.13%) of the 357 patients with intracerebral hemorrhage (ICH). Among the patients with ICH, there were 83 smokers, accounting for 23.24%. The average patient age was 56.21 ± 13.75 years, and 74.51% were male. Compared with the absence of heterogeneity, the risk of hematoma expansion increased by 1.06 times (odds ratio, 2.06; 95% confidence interval, 1.10–3.86). Based on the subgroup analysis, smoking status was found to modify the association between heterogeneity and hematoma expansion; the association was stronger in smokers than in nonsmokers (odds ratio, 10.23; 95% confidence interval, 2.15–48.65). Conclusions Heterogeneity independently predicts hematoma expansion, especially in smoking patients.
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Affiliation(s)
- Haihua Wei
- Department of Radiology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, Shenzhen, China.,The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Hongye Feng
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Minrui Lv
- Department of Radiology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Ying Zhong
- The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xiaolin Yang
- Department of Radiology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, Shenzhen, China.,The First Clinical Medical College, Guangdong Medical University, Zhanjiang, China
| | - Xi Zhou
- Department of Radiology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhihao Lei
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University, Shenzhen, China
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21
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Morotti A, Arba F, Boulouis G, Charidimou A. Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome: A meta-analysis. Neurology 2020; 95:632-643. [PMID: 32847959 DOI: 10.1212/wnl.0000000000010660] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/22/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis. METHODS We searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3-6 or 4-6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker. RESULTS We included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42-9.64 and OR = 5.26, 95% CI = 1.75-15.76), swirl sign (OR = 3.33, 95% CI = 2.42-4.60 and OR = 3.70; 95% CI = 2.47-5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71-4.39 and OR = 2.80; 95% CI = 1.78-4.39), blend sign (OR = 3.49; 95% CI = 2.20-5.55 and OR = 2.21; 95% CI 1.16-4.18), hypodensities (OR = 3.47; 95% CI = 2.18-5.50 and OR = 2.94; 95% CI = 2.28-3.78), irregular shape (OR = 2.01, 95% CI = 1.27-3.19 and OR = 3.43; 95% CI = 2.33-5.03), and island sign (OR = 7.87, 95% CI = 2.17-28.47 and OR = 6.05, 95% CI = 4.44-8.24). CONCLUSION Our results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston.
| | - Francesco Arba
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Gregoire Boulouis
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Andreas Charidimou
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
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22
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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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Lei K, Wei S, Liu X, Yuan X, Pei L, Xu Y, Song B, Sun S. Combination of Ultraearly Hematoma Growth and Hypodensities for Outcome Prediction after Intracerebral Hemorrhage. World Neurosurg 2019; 135:e610-e615. [PMID: 31870816 DOI: 10.1016/j.wneu.2019.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Noncontrast computed tomography hypodensities (HD) and ultraearly hematoma growth (uHG) are reliable markers for outcome prediction in patients with spontaneous intracerebral hemorrhage (sICH). The present study aimed to assess whether the combination of these 2 markers could improve the prognostic value for sICH. METHODS We recruited 242 patients with sICH who had been admitted within 6 hours from the onset of symptoms. HD was assessed by 2 independent blinded readers, and uHG was calculated as baseline ICH volume/onset-to-imaging time. We divided the study population into 4 groups: uHG(L) HD(-) (uHG <6.16 mL/hour and HD negative), uHG(L) HD(+) (uHG<6.16 mL/hour and HD positive), uHG(H) HD(-) (uHG ≥6.16 mL/hour and HD negative), and uHG(H) HD(+) (uHG ≥6.16 mL/h and HD positive). The outcome at 90 days was evaluated by the modified Rankin Scale (mRS) score and was dichotomized as good (mRS score 0-3) and poor (mRS score 4-6). The association between the combined indicators and unfavorable outcome was investigated using multivariable logistic regression models. RESULTS Patients with poor outcomes were more likely to have HD and higher uHG in univariate analysis. In multivariate logistic regression analysis, uHG(H) HD(+) had a higher risk of unfavorable outcomes compared with uHG(L) HD(-) (odds ratio [OR], 5.710; P < 0.001). In addition, the risk of unfavorable outcomes was increased in uHG(H) HD(-) (OR, 2.957, P = 0.044) and uHG(L) HD(+) (OR, 1.924; P = 0.232). The proportions of unfavorable prognoses were 32.6% in uHG(L) HD(-), 48.3% in uHG(L) HD(+), 72.2% in uHG(H) HD(-), and 87.5% in uHG(H) HD(+) (P < 0.001). CONCLUSIONS The combination of uHG and HD improves the stratification of unfavorable prognoses in patients with sICH.
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Affiliation(s)
- Kunlun Lei
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Sen Wei
- Department of Neurological Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xinjing Liu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xin Yuan
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lulu Pei
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuming Xu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bo Song
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shilei Sun
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
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Kim H, Goo JH, Kwak HS, Hwang SB, Chung GH. Correlation between Spot Sign and Intracranial Hemorrhage Expansion on Dual-Phase CT Angiography. Diagnostics (Basel) 2019; 9:diagnostics9040215. [PMID: 31817933 PMCID: PMC6963721 DOI: 10.3390/diagnostics9040215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: Expansion of intracranial hemorrhage (ICH) is an important predictor of poor clinical outcome. ICH expansion can be predicted with a spot sign on computed tomographic angiography (CTA). We aimed to evaluate the correlation between spot signs on CTA and ICH expansion on dual-phase CTA. Methods: Patients with spontaneous ICH between January 2017 and April 2019 who underwent an initial CT, dual-phase CTA, and a subsequent CT were retrospectively identified. ICH expansion was defined as volume growth of >33% or >6 mL. We analyzed the presence and change in size of the spot sign in the first phase and second phase CTA. Also, we divided the morphological status of the spot sign, such as a dot-like lesion or linear contrast extravasation, in the first and second phase CTA. Results: A total of 206 patients, including 38 (18.5%) with ICH expansion and 45 (21.8%) with a spot sign, qualified for analysis. Of patients with a spot sign, 26 (57.8%) had ICH expansion on subsequent CT. Increased size of a spot sign in second-phase CTA was more frequent in the ICH expansion group than in the no-expansion group (96.2% vs. 52.6%, p < 0.001). First visualization of a spot sign in the second phase was more common in the no-expansion group than in the ICH expansion group (47.4% vs. 3.8%, p < 0.001). The morphological patterns of a spot sign between the two groups were not significantly different. Conclusion: Spot signs on dual-phase CTA have different sizes and morphological patterns. Increased size of a spot sign in the second phase of CTA can help identify patients at risk for ICH expansion.
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Affiliation(s)
- Hyesoo Kim
- Medical School, Chonbuk National University, Jeonju-si 54896, Korea; (H.K.); (J.H.G.)
| | - Ja Hong Goo
- Medical School, Chonbuk National University, Jeonju-si 54896, Korea; (H.K.); (J.H.G.)
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Geonji-ro Jeonju-si 54907 20, Korea; (S.B.H.); (G.H.C.)
- Correspondence: ; Tel.: +82-63-250-2582
| | - Seung Bae Hwang
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Geonji-ro Jeonju-si 54907 20, Korea; (S.B.H.); (G.H.C.)
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Geonji-ro Jeonju-si 54907 20, Korea; (S.B.H.); (G.H.C.)
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25
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Zachrison KS, Aaronson E, Mahmood S, Rosand J, Viswanathan A, Schwamm LH, Goldstein JN. Resource utilisation among patients transferred for intracerebral haemorrhage. Stroke Vasc Neurol 2019; 4:223-226. [PMID: 32030206 PMCID: PMC6979870 DOI: 10.1136/svn-2019-000255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/23/2019] [Accepted: 09/12/2019] [Indexed: 11/21/2022] Open
Abstract
Background Patients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. We aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital. Methods We used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015. The primary outcome was use of either intensive care unit (ICU) admission or surgical intervention. Logistic regression examined factors associated with the outcome, controlling for age, sex, Glasgow coma score (GCS) and ICH score. Results Of the 2008 patients included, 887 (44.2%) received ICU stay or surgical intervention. These patients were younger (71 vs 74 years, p<0.001), less often white (83.9% vs 89.3%, p<0.001), had lower baseline GCS (12 vs 14, p<0.001) and more frequently had intraventricular haemorrhage (58.6% vs 43.4%, p<0.001). Factors independently associated with ICU stay or surgical intervention were age >65 years (OR 0.38, 95% CI 0.21 to 0.69), GCS <15 (1.23, 95% CI 1.01 to 1.52) and ICH score >0 (OR 2.23, 95% CI 1.70 to 2.91). Conclusion Among this cohort of primary patients with ICH, GCS of 15 and ICH score of 0 were associated with less frequent use of ICU or intervention. These results should be validated in a larger sample but may be valuable for hospitals considering which patients with ICH could safely remain at the referring facility.
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Affiliation(s)
- Kori Sauser Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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26
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Xiang Y, Zhang T, Li Y, Liu J, Xu H, He W, Chen Q, Yang Y. Comparison of Ultra-Early Hematoma Growth and Common Noncontrast Computed Tomography Features in Predicting Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage. World Neurosurg 2019; 134:e75-e81. [PMID: 31648055 DOI: 10.1016/j.wneu.2019.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Ultra-early hematoma growth (uHG), the black hole sign, and the blend sign are common predictors of hematoma enlargement (HE). This study aimed to develop a new diagnostic criterion for predicting HE using uHG and to compare the accuracy of uHG, the black hole sign, and the blend sign in predicting HE in patients with spontaneous intracerebral hemorrhage (sICH). METHODS We retrospectively analyzed data of 920 patients with sICH from August 2013 to January 2018. Receiver operating characteristic curves were plotted to determine the optimal threshold values of uHG to predict HE. The effects of the black hole sign, blend sign, and uHG on HE were assessed using univariate and multivariate logistic regression models, and their prediction accuracies were analyzed using receiver operator analyses. RESULTS The black hole sign was identified in 131 patients, the blend sign in 163 patients, and uHG >6.46 mL/h in 441 patients. Logistic analysis showed that the black hole sign, blend sign, and uHG >6.46 mL/h were independent predictors of HE. The sensitivity values of uHG >6.46 mL/h, the black hole sign, and the blend sign were 70.43%, 24.19%, and 36.56%, respectively, and specificity values were 57.77%, 88.28%, and 87.06%, respectively. uHG had the greatest area under the curve. The black hole and blend signs were more commonly found in patients with uHG >6.46 mL/h (P < 0.001). CONCLUSIONS uHG >6.46 mL/h was the optimal predictor used for identifying patients at high risk of developing HE. A greater uHG value was associated with an increased prevalence of the black hole and blend signs.
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Affiliation(s)
- Yilan Xiang
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingting Zhang
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanxuan Li
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinjin Liu
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoli Xu
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenwen He
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qian Chen
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunjun Yang
- Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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27
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Quintas-Neves M, Marques L, Silva L, Amorim JM, Ferreira C, Pinho J. Noncontrast computed tomography markers of outcome in intracerebral hemorrhage patients. Neurol Res 2019; 41:1083-1089. [DOI: 10.1080/01616412.2019.1673279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | - Lénia Silva
- School of Medicine, University of Minho, Braga, Portugal
| | | | - Carla Ferreira
- Neurology Department, Hospital de Braga, Braga, Portugal
| | - João Pinho
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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28
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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: 106] [Impact Index Per Article: 21.2] [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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29
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Yogendrakumar V, Ramsay T, Fergusson D, Demchuk AM, Aviv RI, Rodriguez-Luna D, Molina CA, Silva Y, Dzialowski I, Kobayashi A, Boulanger JM, Lum C, Gubitz G, Srivastava P, Roy J, Kase CS, Bhatia R, Hill MD, Warren AD, Anderson CD, Gurol ME, Greenberg SM, Viswanathan A, Rosand J, Goldstein JN, Dowlatshahi D. New and expanding ventricular hemorrhage predicts poor outcome in acute intracerebral hemorrhage. Neurology 2019; 93:e879-e888. [PMID: 31371565 DOI: 10.1212/wnl.0000000000008007] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/04/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To describe the relationship between intraventricular hemorrhage (IVH) expansion and long-term outcome and to use this relationship to select and validate clinically relevant thresholds of IVH expansion in 2 separate intracerebral hemorrhage (ICH) populations. METHODS We used fractional polynomial analysis to test linear and nonlinear models of 24-hour IVH volume change and clinical outcome with data from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT)-ICH study. The primary outcome was poor clinical outcome (modified Rankin Scale [mRS] score 4-6) at 90 days. We derived dichotomous thresholds from the selected model and calculated diagnostic accuracy measures. We validated all thresholds in an independent single-center ICH cohort (Massachusetts General Hospital). RESULTS Of the 256 patients from PREDICT, 127 (49.6%) had an mRS score of 4 to 6. Twenty-four-hour IVH volume change and poor outcome fit a nonlinear relationship, in which minimal increases in IVH were associated with a high probability of an mRS score of 4 to 6. IVH expansion ≥1 mL (n = 53, sensitivity 33%, specificity 92%, adjusted odds ratio [aOR] 2.68, 95% confidence interval [CI] 1.11-6.46) and development of any new IVH (n = 74, sensitivity 43%, specificity 85%, aOR 2.53, 95% CI 1.22-5.26) strongly predicted poor outcome at 90 days. The dichotomous thresholds reproduced well in a validation cohort of 169 patients. CONCLUSION IVH expansion as small as 1 mL or any new IVH is strongly predictive of poor outcome. These findings may assist clinicians with bedside prognostication and could be incorporated into definitions of hematoma expansion to inform future ICH treatment trials.
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Affiliation(s)
- Vignan Yogendrakumar
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Tim Ramsay
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Dean Fergusson
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrew M Demchuk
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Richard I Aviv
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - David Rodriguez-Luna
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Carlos A Molina
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Yolanda Silva
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Imanuel Dzialowski
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Adam Kobayashi
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jean-Martin Boulanger
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Cheemun Lum
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Gord Gubitz
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Padma Srivastava
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jayanta Roy
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Carlos S Kase
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Rohit Bhatia
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michael D Hill
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Mahmut E Gurol
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steve M Greenberg
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Dar Dowlatshahi
- From the Ottawa Stroke Program (V.Y., D.D.), Department of Medicine (Neurology), Department of Radiology (C.L.), Ottawa Methods Center (T.R., D.F.), and Ottawa Hospital Research Institute (T.R., D.F., D.D.), University of Ottawa, Ontario; Calgary Stroke Program (A.M.D., M.D.H.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Neurology (D.R.-L., C.A.M.), Hospital Universitari Vall d'Hebron, Barcelona; Department of Neurology (Y.S.), Dr. Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), Elblandklinikum Meissen Academic Teaching Hospital of Technische University, Dresden, Germany; Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology (A.K.), Institute of Psychiatry and Neurology, and Department of Experimental and Clinical Pharmacology, Warsaw, Poland; Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Quebec; Department of Neurology (G.G.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Neurology (P.S., R.B.), All India Institute of Medical Sciences, New Delhi; Apollo Gleneagles Hospitals (J.R.), Kolkata, India; Department of Neurology (C.S.K.), Boston Medical Center; and Department of Neurology (A.D.W., C.D.A., M.E.G., S.M.G., A.V., J.R.), Henry and Allison McCance Center for Brain Health (J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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Park BK, Kwak HS, Chung GH, Hwang SB. Diagnostic value of swirl sign on noncontrast computed tomography and spot sign on computed tomographic angiography to predict intracranial hemorrhage expansion. Clin Neurol Neurosurg 2019; 182:130-135. [PMID: 31121472 DOI: 10.1016/j.clineuro.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Intracranial hemorrhage (ICH) expansion is a predictor of poor clinical outcome. ICH expansion can be predicted with a swirl sign on noncontrast computed tomography (NCCT) and/or a spot sign on computed tomographic angiography (CTA). In this study, we aimed to evaluate the diagnostic value of a swirl sign and a spot sign in identifying hematoma expansion. PATIENTS AND METHODS Patients with spontaneous ICH between January 2013 and August 2018 who underwent an initial NCCT and CTA, and a subsequent NCCT at a single center were retrospectively identified. Two experienced neuroradiologists reviewed all images for swirl sign and spot sign presence using a 4-point scale for receiver-operative characteristic analysis. ICH expansion was defined as volume growth of >33% or >6 mL. RESULTS A total of 227 patients, including 54 with ICH expansion, qualified for analysis. For both observers, the area under the curve (AUC) of spot sign was significantly higher than that of swirl sign (observer 1: 0.748 vs. 0.577, p = .002; observer 2: 0.749 vs. 0.589, p = .004). The sensitivities of ICH expansion in patients with a spot sign was significantly higher than patients with a swirl sign (observer 1: 54.1% vs. 28.0%, p = .002; observer 2: 56.9% vs. 30.3%, p = .002). Patients with a spot sign had the highest risk of ICH expansion (odds ratio: observer 1 = 8.14, observer 2 = 9.30, p < 0.001). CONCLUSIONS A spot sign on CTA was identified and associated with ICH expansion. A swirl sign on NCCT had a relatively low sensitivity and AUC, and will not be able to replace spot sign on CTA.
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Affiliation(s)
- Bo Kyoung Park
- Chonbuk National University Medical School, Republic of Korea
| | - Hyo Sung Kwak
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Republic of Korea.
| | - Gyung Ho Chung
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Republic of Korea
| | - Seung Bae Hwang
- Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Republic of Korea
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Morotti A, Busto G, Bernardoni A, Tamborino C, Fainardi E. Association between perihematomal cerebral blood volume and intracerebral hemorrhage expansion: A computed tomography perfusion study. Ann Neurol 2019; 85:943-947. [DOI: 10.1002/ana.25466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/10/2022]
Affiliation(s)
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical SciencesUniversity of Florence Florence Italy
| | - Andrea Bernardoni
- Neuroradiology Unit, Department of RadiologyArcispedale S. Anna Ferrara Italy
| | - Carmine Tamborino
- Neurology UnitOspedale dell'Angelo, Azienda Ulss 3 Serenissima Mestre Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical SciencesUniversity of Florence Florence Italy
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