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Yu F, Yang M, He C, Yang Y, Peng Y, Yang H, Lu H, Liu H. CT radiomics combined with clinical and radiological factors predict hematoma expansion in hypertensive intracerebral hemorrhage. Eur Radiol 2024:10.1007/s00330-024-10921-2. [PMID: 38990325 DOI: 10.1007/s00330-024-10921-2] [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: 11/27/2023] [Revised: 04/24/2024] [Accepted: 05/19/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES This study aimed to establish a hematoma expansion (HE) prediction model for hypertensive intracerebral hemorrhage (HICH) patients by combining CT radiomics, clinical information, and conventional imaging signs. METHODS A retrospective continuous collection of HICH patients from three medical centers was divided into a training set (n = 555), a validation set (n = 239), and a test set (n = 77). Extract radiomics features from baseline CT plain scan images and combine them with clinical information and conventional imaging signs to construct radiomics models, clinical imaging sign models, and hybrid models, respectively. The models will be evaluated using the area under the curve (AUC), clinical decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). RESULTS In the training, validation, and testing sets, the radiomics model predicts an AUC of HE of 0.885, 0.827, and 0.894, respectively, while the clinical imaging sign model predicts an AUC of HE of 0.759, 0.725, and 0.765, respectively. Glasgow coma scale score at admission, first CT hematoma volume, irregular hematoma shape, and radiomics score were used to construct a hybrid model, with AUCs of 0.901, 0.838, and 0.917, respectively. The DCA shows that the hybrid model had the highest net profit rate. Compared with the radiomics model and the clinical imaging sign model, the hybrid model showed an increase in NRI and IDI. CONCLUSION The hybrid model based on CT radiomics combined with clinical and radiological factors can effectively individualize the evaluation of the risk of HE in patients with HICH. CLINICAL RELEVANCE STATEMENT CT radiomics combined with clinical information and conventional imaging signs can identify HICH patients with a high risk of HE and provide a basis for clinical-targeted treatment. KEY POINTS HE is an important prognostic factor in patients with HICH. The hybrid model predicted HE with training, validation, and test AUCs of 0.901, 0.838, and 0.917, respectively. This model provides a tool for a personalized clinical assessment of early HE risk.
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Affiliation(s)
- Fei Yu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Engineering Research Center of Intelligent Medical Imaging in Guizhou Higher Education Institutions, Zunyi, China
- Department of Medical Imaging, Chongqing Emergency Medical Center, Chongqing University Central Hospital, The Fourth People's Hospital of Chongqing, Chongqing, China
| | - Mingguang Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Engineering Research Center of Intelligent Medical Imaging in Guizhou Higher Education Institutions, Zunyi, China
- Department of Medical Imaging, Chongqing Emergency Medical Center, Chongqing University Central Hospital, The Fourth People's Hospital of Chongqing, Chongqing, China
| | - Cheng He
- Department of Medical Imaging, Chongqing Emergency Medical Center, Chongqing University Central Hospital, The Fourth People's Hospital of Chongqing, Chongqing, China
| | - Yanli Yang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Engineering Research Center of Intelligent Medical Imaging in Guizhou Higher Education Institutions, Zunyi, China
| | - Ying Peng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Engineering Research Center of Intelligent Medical Imaging in Guizhou Higher Education Institutions, Zunyi, China
| | - Hua Yang
- Department of Medical Imaging, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Hong Lu
- Department of Radiology, The Seventh People's Hospital of Chongqing, The Central Hospital Affiliated to Chongqing University of Technology, Chongqing, China
| | - Heng Liu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Engineering Research Center of Intelligent Medical Imaging in Guizhou Higher Education Institutions, Zunyi, China.
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Wang JY, Wilson M, Andreev A, Tarsia J, Selim M, Lioutas VA. The role of hyperglycemia in the outcome of intracerebral hemorrhage: A causative analysis. J Stroke Cerebrovasc Dis 2023; 32:107439. [PMID: 38488808 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107439] [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: 08/07/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Hyperglycemia in the acute phase of intracerebral hemorrhage (ICH) has been associated with poor functional outcomes, however all interventions to lower glucose have yielded neutral or negative results. We attempt an explanation of the causal role of hyperglycemia in ΙCH outcome using generalized structural equation modeling. MATERIALS AND METHODS Consecutive primary ICH patients admitted to an academic hospital between 2007 and 2018 were identified. Patients with missing baseline or follow up CT scans and without 90 day follow up status were excluded. We constructed a causal model accounting for pre-defined markers of ICH severity to evaluate the association between mean 72 h glucose and 90 day functional outcome measured by modified Rankin Scale, dichotomized as favorable ≤2 or unfavorable >2. RESULTS Primary analyses included 410 patients (70.4 ± 13.8years, 43 % female). Mean 72 h glucose was 137.5 ± 33.4mg/dl and 102 (25 %) patients were diabetic. On univariable analysis, higher glucose levels were negatively correlated with favorable outcome (p < 0.0001). However in the structural equation model, this relationship was significantly attenuated (p = 0.06) after accounting for the causal effect of diabetes (p < 0.0001), hematoma volume (p < 0.0001), intraventricular extension (p = 0.01) and Glasgow coma scale (p = 0.001) on glucose levels. On secondary analyses stratifying by diagnosis of diabetes, higher glucose levels were negatively correlated with favorable outcome in patients without diabetes (p = 0.04), but not in patients with diabetes (p = 0.35). CONCLUSIONS Hyperglycemia may be a downstream effect of other markers of ICH severity, particularly among patients without diabetes, suggesting a possible explanation for the limited evidence of glucose lowering interventions in outcome.
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Affiliation(s)
- Jia-Yi Wang
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Mitchell Wilson
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Alexander Andreev
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Joseph Tarsia
- Department of Neurology, Ochsner Medical Center, New Orleans, LA, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
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Serrano E, Moreno J, Llull L, Rodríguez A, Zwanzger C, Amaro S, Oleaga L, López-Rueda A. Radiomic-based nonlinear supervised learning classifiers on non-contrast CT to predict functional prognosis in patients with spontaneous intracerebral hematoma. RADIOLOGIA 2023; 65:519-530. [PMID: 38049251 DOI: 10.1016/j.rxeng.2023.08.002] [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: 05/21/2023] [Accepted: 08/03/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE To evaluate if nonlinear supervised learning classifiers based on non-contrast CT can predict functional prognosis at discharge in patients with spontaneous intracerebral hematoma. METHODS Retrospective, single-center, observational analysis of patients with a diagnosis of spontaneous intracerebral hematoma confirmed by non-contrast CT between January 2016 and April 2018. Patients with HIE > 18 years and with TCCSC performed within the first 24 h of symptom onset were included. Patients with secondary spontaneous intracerebral hematoma and in whom radiomic variables were not available were excluded. Clinical, demographic and admission variables were collected. Patients were classified according to the Modified Rankin Scale (mRS) at discharge into good (mRS 0-2) and poor prognosis (mRS 3-6). After manual segmentation of each spontaneous intracerebral hematoma, the radiomics variables were obtained. The sample was divided into a training and testing cohort and a validation cohort (70-30% respectively). Different methods of variable selection and dimensionality reduction were used, and different algorithms were used for model construction. Stratified 10-fold cross-validation were performed on the training and testing cohort and the mean area under the curve (AUC) were calculated. Once the models were trained, the sensitivity of each was calculated to predict functional prognosis at discharge in the validation cohort. RESULTS 105 patients with spontaneous intracerebral hematoma were analyzed. 105 radiomic variables were evaluated for each patient. P-SVM, KNN-E and RF-10 algorithms, in combination with the ANOVA variable selection method, were the best performing classifiers in the training and testing cohort (AUC 0.798, 0.752 and 0.742 respectively). The predictions of these models, in the validation cohort, had a sensitivity of 0.897 (0.778-1;95%CI), with a false-negative rate of 0% for predicting poor functional prognosis at discharge. CONCLUSION The use of radiomics-based nonlinear supervised learning classifiers are a promising diagnostic tool for predicting functional outcome at discharge in HIE patients, with a low false negative rate, although larger and balanced samples are still needed to develop and improve their performance.
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Affiliation(s)
- E Serrano
- Departamento Radiología, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - J Moreno
- Clínica Iribas-IRM, Asunción, Paraguay
| | - L Llull
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - A Rodríguez
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - C Zwanzger
- Departamento Radiología, Hospital del Mar, Barcelona, Spain
| | - S Amaro
- Departamento de Neurología, Hospital Clínic, Barcelona, Spain
| | - L Oleaga
- Departamento Radiología, Hospital Clínic, Barcelona, Spain
| | - A López-Rueda
- Departamento Radiología, Hospital Clínic, Barcelona, Spain; Servicio de Informática Clínica, Hospital Clínic, Barcelona, Spain.
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Choi JH, Yoon WK, Kim JH, Kwon TH, Byun J. Predictor of the Postoperative Swelling After Craniotomy for Spontaneous Intracerebral Hemorrhage: Sphericity Index as a Novel Parameter. Korean J Neurotrauma 2023; 19:333-347. [PMID: 37840614 PMCID: PMC10567521 DOI: 10.13004/kjnt.2023.19.e41] [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: 07/19/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Spontaneous intracerebral hemorrhage is a serious type of stroke with high mortality and disability rates. Surgical treatment options vary; however, predicting edema aggravation is crucial when choosing the optimal approach. We propose using the sphericity index, a measure of roundness, to predict the aggravation of edema and guide surgical decisions. Methods We analyzed 56 cases of craniotomy and hematoma evacuation to investigate the correlation between the sphericity index and patient outcomes, including the need for salvage decompressive craniectomy (DC). Results The patients included 35 (62.5%) men and 21 (37.5%) women, with a median age of 62.5 years. The basal ganglia was the most common location of hemorrhage (50.0%). The mean hematoma volume was 86.3 cc, with 10 (17.9%) instances of hematoma expansion. Cerebral herniation was observed in 44 (78.6%) patients, intraventricular hemorrhage in 34 (60.7%), and spot signs in 9 (16.1%). Salvage DC was performed in 13 (23.6%) patients to relieve intracranial pressure. The median follow-up duration was 6 months, with a mortality rate of 12.5%. The sphericity index was significantly correlated with delayed swelling and hematoma expansion but not salvage DC. Conclusions The sphericity index is a promising predictor of delayed swelling and hematoma expansion that may aid in the development of surgical guidelines and medication strategies. Further large-scale studies are required to explore these aspects and establish comprehensive guidelines.
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Affiliation(s)
- Jae Hoon Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Ki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Taek Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joonho Byun
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Suprasanna K, HB S, Ravikiran SR, Jain I, Holla V. Hematological indices as predictors of intracerebral hematoma expansion detected on serial computed tomography. BRAIN HEMORRHAGES 2023. [DOI: 10.1016/j.hest.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Tong S, Gu S, Lu M, Ying H. Surface regularity: a new factor for predicting the expansion of intracerebral hemorrhage? INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Hillal A, Sultani G, Ramgren B, Norrving B, Wassélius J, Ullberg T. Accuracy of automated intracerebral hemorrhage volume measurement on non-contrast computed tomography: a Swedish Stroke Register cohort study. Neuroradiology 2023; 65:479-488. [PMID: 36323862 PMCID: PMC9905189 DOI: 10.1007/s00234-022-03075-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Hematoma volume is the strongest predictor of patient outcome after intracerebral hemorrhage (ICH). The aim of this study was to validate novel fully automated software for quantification of ICH volume on non-contrast computed tomography (CT). METHODS The population was defined from the Swedish Stroke Register (RS) and included all patients with an ICH diagnosis during 2016-2019 in Region Skåne. Hemorrhage volume on their initial head CT was measured using ABC/2 and manual segmentation (Sectra IDS7 volume measurement tool) and the automated volume quantification tool (qER-NCCT) by Qure.ai. The first 500 were examined by two independent readers. RESULTS A total of 1649 ICH patients were included. The qER-NCCT had 97% sensitivity in identifying ICH. In total, there was excellent agreement between volumetric measurements of ICH volumes by qER-NCCT and manual segmentation by interclass correlation (ICC = 0.96), and good agreement (ICC = 0.86) between qER-NCCT and ABC/2 method. The qER-NCCT showed volume underestimation, mainly in large (> 30 ml) heterogenous hemorrhages. Interrater agreement by (ICC) was 0.996 (95% CI: 0.99-1.00) for manual segmentation. CONCLUSION Our study showed excellent agreement in volume quantification between the fully automated software qER-NCCT and manual segmentation of ICH on NCCT. The qER-NCCT would be an important additive tool by aiding in early diagnostics and prognostication for patients with ICH and in provide volumetry on a population-wide level. Further refinement of the software should address the underestimation of ICH volume seen in a portion of large, heterogenous, irregularly shaped ICHs.
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Affiliation(s)
- Amir Hillal
- Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden ,Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden
| | - Gabriella Sultani
- Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden ,Department of Neurology, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Birgitta Ramgren
- Medical Imaging and Physiology, Skåne University Hospital, 221 85 Lund, Sweden ,Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden ,Department of Neurology, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Johan Wassélius
- Medical Imaging and Physiology, Skåne University Hospital, 221 85, Lund, Sweden. .,Department of Clinical Sciences Lund, Lund University, 221 85, Lund, Sweden.
| | - Teresa Ullberg
- Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden ,Department of Neurology, Skåne University Hospital, 205 02 Malmö, Sweden
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Hillal A, Ullberg T, Ramgren B, Wassélius J. Computed tomography in acute intracerebral hemorrhage: neuroimaging predictors of hematoma expansion and outcome. Insights Imaging 2022; 13:180. [DOI: 10.1186/s13244-022-01309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022] Open
Abstract
AbstractIntracerebral hemorrhage (ICH) accounts for 10–20% of all strokes worldwide and is associated with serious outcomes, including a 30-day mortality rate of up to 40%. Neuroimaging is pivotal in diagnosing ICH as early detection and determination of underlying cause, and risk for expansion/rebleeding is essential in providing the correct treatment. Non-contrast computed tomography (NCCT) is the most used modality for detection of ICH, identification of prognostic markers and measurements of hematoma volume, all of which are of major importance to predict outcome. The strongest predictors of 30-day mortality and functional outcome for ICH patients are baseline hematoma volume and hematoma expansion. Even so, exact hematoma measurement is rare in clinical routine practice, primarily due to a lack of tools available for fast, effective, and reliable volumetric tools. In this educational review, we discuss neuroimaging findings for ICH from NCCT images, and their prognostic value, as well as the use of semi-automatic and fully automated hematoma volumetric methods and assessment of hematoma expansion in prognostic studies.
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Tang ZR, Chen Y, Hu R, Wang H. Predicting hematoma expansion in intracerebral hemorrhage from brain CT scans via K-nearest neighbors matting and deep residual network. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yang Q, Sun J, Guo Y, Zeng P, Jin K, Huang C, Xu J, Hou L, Li C, Feng J. Radiomics Features on Computed Tomography Combined With Clinical-Radiological Factors Predicting Progressive Hemorrhage of Cerebral Contusion. Front Neurol 2022; 13:839784. [PMID: 35775053 PMCID: PMC9237337 DOI: 10.3389/fneur.2022.839784] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/29/2022] [Indexed: 01/02/2023] Open
Abstract
Background Traumatic brain injury (TBI) is the main cause of death and severe disability in young adults worldwide. Progressive hemorrhage (PH) worsens the disease and can cause a poor neurological prognosis. Radiomics analysis has been used for hematoma expansion of hypertensive intracerebral hemorrhage. This study attempts to develop an optimal radiomics model based on non-contrast CT to predict PH by machine learning (ML) methods and compare its prediction performance with clinical-radiological models. Methods We retrospectively analyzed 165 TBI patients, including 89 patients with PH and 76 patients without PH, whose data were randomized into a training set and a testing set at a ratio of 7:3. A total of 10 different machine learning methods were used to predict PH. Univariate and multivariable logistic regression analyses were implemented to screen clinical-radiological factors and to establish a clinical-radiological model. Then, a combined model combining clinical-radiological factors with the radiomics score was constructed. The area under the receiver operating characteristic curve (AUC), accuracy and F1 score, sensitivity, and specificity were used to evaluate the models. Results Among the 10 various ML algorithms, the support vector machine (SVM) had the best prediction performance based on 12 radiomics features, including the AUC (training set: 0.918; testing set: 0.879) and accuracy (training set: 0.872; test set: 0.834). Among the clinical and radiological factors, the onset-to-baseline CT time, the scalp hematoma, and fibrinogen were associated with PH. The radiomics model's prediction performance was better than the clinical-radiological model, while the predictive nomogram combining the radiomics features with clinical-radiological characteristics performed best. Conclusions The radiomics model outperformed the traditional clinical-radiological model in predicting PH. The nomogram model of the combined radiomics features and clinical-radiological factors is a helpful tool for PH.
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Affiliation(s)
- Qingning Yang
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
| | - Jun Sun
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
| | - Yi Guo
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
- *Correspondence: Yi Guo
| | - Ping Zeng
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
- Ping Zeng
| | - Ke Jin
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Beijing, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Beijing, China
| | - Jingxu Xu
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Beijing, China
| | - Liran Hou
- Department of Radiology, Panjiang Central Hospital, Guizhou, China
| | - Chuanming Li
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
| | - Junbang Feng
- Department of Radiology, Chongqing University Central Hospital, Chongqing, China
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Guo DC, Gu J, He J, Chu HR, Dong N, Zheng YF. External validation study on the value of deep learning algorithm for the prediction of hematoma expansion from noncontrast CT scans. BMC Med Imaging 2022; 22:45. [PMID: 35287616 PMCID: PMC8922885 DOI: 10.1186/s12880-022-00772-y] [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: 12/23/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hematoma expansion is an independent predictor of patient outcome and mortality. The early diagnosis of hematoma expansion is crucial for selecting clinical treatment options. This study aims to explore the value of a deep learning algorithm for the prediction of hematoma expansion from non-contrast computed tomography (NCCT) scan through external validation. Methods 102 NCCT images of hypertensive intracerebral hemorrhage (HICH) patients diagnosed in our hospital were retrospectively reviewed. The initial computed tomography (CT) scan images were evaluated by a commercial Artificial Intelligence (AI) software using deep learning algorithm and radiologists respectively to predict hematoma expansion and the corresponding sensitivity, specificity and accuracy of the two groups were calculated and compared. Comparisons were also conducted among gold standard hematoma expansion diagnosis time, AI software diagnosis time and doctors’ reading time. Results Among 102 HICH patients, the sensitivity, specificity, and accuracy of hematoma expansion prediction in the AI group were higher than those in the doctor group(80.0% vs 66.7%, 73.6% vs 58.3%, 75.5% vs 60.8%), with statistically significant difference (p < 0.05). The AI diagnosis time (2.8 ± 0.3 s) and the doctors’ diagnosis time (11.7 ± 0.3 s) were both significantly shorter than the gold standard diagnosis time (14.5 ± 8.8 h) (p < 0.05), AI diagnosis time was significantly shorter than that of doctors (p < 0.05). Conclusions Deep learning algorithm could effectively predict hematoma expansion at an early stage from the initial CT scan images of HICH patients after onset with high sensitivity and specificity and greatly shortened diagnosis time, which provides a new, accurate, easy-to-use and fast method for the early prediction of hematoma expansion.
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Affiliation(s)
- Dong Chuang Guo
- Department of Radiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, Zhejiang Province, China
| | - Jun Gu
- Institute of Clinical Research, Biomind Technology, Beijing, 100050, China
| | - Jian He
- Department of Radiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, Zhejiang Province, China
| | - Hai Rui Chu
- Department of Radiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, Zhejiang Province, China
| | - Na Dong
- Institute of Clinical Research, Biomind Technology, Beijing, 100050, China
| | - Yi Feng Zheng
- Department of Radiology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, 313000, Zhejiang Province, China.
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Wang L, Luo S, Ren S, Yu H, Shen G, Wu G, Yang Q. Irregular-Shaped Hematoma Predicts Postoperative Rehemorrhage After Stereotactic Minimally Invasive Surgery for Intracerebral Hemorrhage. Front Neurol 2022; 13:727702. [PMID: 35359642 PMCID: PMC8961737 DOI: 10.3389/fneur.2022.727702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeMinimally invasive surgery (MIS) is performed to treat patients with intracerebral hemorrhage (ICH) with favorable results. However, postoperative rehemorrhage is a significant risk. The present study retrospectively analyzed the association of irregular-shaped hematoma with postoperative rehemorrhage following stereotactic MIS (sMIS).MethodsWe enrolled 548 patients with spontaneous ICH who underwent sMIS. Based on the hematoma shape, the patients were assigned to the regular-shaped hematoma group (RSH group; 300 patients) or irregular-shaped hematoma group (ISH group; 248 patients). Logistic regression analysis was performed to identify the predictors of postoperative rehemorrhage after sMIS for ICH evacuation. The functional outcome was assessed using the modified ranking scale (mRS) score at discharge. A receiver operating characteristic (ROC) curve was used to confirm the results.ResultsAmong 548 patients with ICH who underwent sMIS, 116 developed postoperative rehemorrhage. Postoperative rehemorrhage occurred in 30.65% of patients with ISH and 13.30% with RSH (P < 0.01), with a significant difference between the ISH and RSH groups. Among 116 patients with postoperative rehemorrhage, 76 (65.52%) showed ISH on CT scan. In 432 patients without postoperative rehemorrhage, only 39.81% displayed ISH. The logistic regression analysis demonstrated that ISH could independently predict postoperative rehemorrhage. The sensitivity, specificity, positive predictive value, and negative predicative value were 0.655, 0.398, 0.655, and 0.602, respectively. The ROC analysis confirmed the value of ISH in predicting postoperative rehemorrhage with an area under the curve of 0.629.ConclusionsIrregular-shaped hematoma was an independent predictor of postoperative rehemorrhage after sMIS.
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Affiliation(s)
- Likun Wang
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Sheng Luo
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Siying Ren
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hui Yu
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Hui Yu
| | - Guiquan Shen
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Guofeng Wu
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Guofeng Wu
| | - Qingwu Yang
- Second Affiliated Hospital of Army Military Medical University, Chongqing, China
- Qingwu Yang
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Wang CY, Zhang YB, Wang JQ, Zhang XT, Pan ZM, Chen LX. Association Between Serum Lactate Dehydrogenase Level and Hematoma Expansion in Patients with Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis. World Neurosurg 2022; 160:e579-e590. [DOI: 10.1016/j.wneu.2022.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
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Rangaraj S, Islam M, Vs V, Wijethilake N, Uppal U, See AAQ, Chan J, James ML, King NKK, Ren H. Identifying risk factors of intracerebral hemorrhage stability using explainable attention model. Med Biol Eng Comput 2021; 60:337-348. [PMID: 34859369 DOI: 10.1007/s11517-021-02459-y] [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: 11/01/2020] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
Segmentation of intracerebral hemorrhage (ICH) helps improve the quality of diagnosis, draft the desired treatment methods, and clinically observe the variations with healthy patients. The clinical utilization of various ICH progression scoring systems has limitations due to the systems' modest predictive value. This paper proposes a single pipeline of a multi-task model for end-to-end hemorrhage segmentation and risk estimation. We introduce a 3D spatial attention unit and integrate it into the state-of-the-art segmentation architecture, UNet, to enhance the accuracy by bootstrapping the global spatial representation. We further extract the geometric features from the segmented hemorrhage volume and fuse them with clinical features such as CT angiography (CTA) spot, Glasgow Coma Scale (GCS), and age to predict the ICH stability. Several state-of-the-art machine learning techniques such as multilayer perceptron (MLP), support vector machine (SVM), gradient boosting, and random forests are applied to train stability estimation and to compare the performances. To align clinical intuition with model learning, we determine the shapely values (SHAP) and explain the most significant features for the ICH risk scoring system. A total of 79 patients are included, of which 20 are found in critical condition. Our proposed single pipeline model achieves a segmentation accuracy of 86.3%, stability prediction accuracy of 78.3%, and precision of 82.9%; the mean square error of exact expansion rate regression is observed to be 0.46. The SHAP analysis reveals that CTA spot sign, age, solidity, location, and length of the first axis of the ICH volume are the most critical characteristics that help define the stability of the stroke lesion. We also show that integrating significant geometric features with clinical features can improve the ICH progression scoring by predicting long-term outcomes. Graphical abstract Overview of our proposed method comprising of spatial attention and feature extraction mechanisms. The architecture is trained on the input CT images, and the first step output is the predicted segmentation of the hemorrhagic region. The output is fed into a geometric feature extractor and is fused with clinical features to estimate ICH stability using a multilayer perceptron (MLP).
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Affiliation(s)
- Seshasayi Rangaraj
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,Department of ECE, National Institute of Technology, Tiruchirappalli, India
| | - Mobarakol Islam
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore, Singapore
| | - Vibashan Vs
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,Department of ECE, National Institute of Technology, Tiruchirappalli, India
| | - Navodini Wijethilake
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,Department of ENTC, University of Moratuwa, Moratuwa, Sri Lanka
| | - Utkarsh Uppal
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.,Department of Electrical Engineering, Punjab Engineering College, Chandigarh, India
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Jasmine Chan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | | | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Neuro Asia Care, Mount Elizabeth Hospital, Singapore, Singapore
| | - Hongliang Ren
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore. .,Department of Electronic Engineering and Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong.
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15
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Kumar S, Andoniadis M, Solhpour A, Asghar S, Fangman M, Ashouri R, Doré S. Contribution of Various Types of Transfusion to Acute and Delayed Intracerebral Hemorrhage Injury. Front Neurol 2021; 12:727569. [PMID: 34777198 PMCID: PMC8586553 DOI: 10.3389/fneur.2021.727569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most prevalent type of stroke, after ischemic stroke, and has exceptionally high morbidity and mortality rates. After spontaneous ICH, one primary goal is to restrict hematoma expansion, and the second is to limit brain edema and secondary injury. Various types of transfusion therapies have been studied as treatment options to alleviate the adverse effects of ICH etiopathology. The objective of this work is to review transfusions with platelets, fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), and red blood cells (RBCs) in patients with ICH. Furthermore, tranexamic acid infusion studies have been included due to its connection to ICH and hematoma expansion. As stated, the first line of therapy is limiting bleeding in the brain and hematoma expansion. Platelet transfusion is used to promote recovery and mitigate brain damage, notably in patients with severe thrombocytopenia. Additionally, tranexamic acid infusion, FFP, and PCC transfusion have been shown to affect hematoma expansion rate and volume. Although there is limited available research, RBC transfusions have been shown to cause higher tissue oxygenation and lower mortality, notably after brain edema, increases in intracranial pressure, and hypoxia. However, these types of transfusion have varied results depending on the patient, hemostasis status/blood thinner, hemolysis, anemia, and complications, among other variables. Inconsistencies in published results on various transfusion therapies led us to review the data and discuss issues that need to be considered when establishing future guidelines for patients with ICH.
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Affiliation(s)
- Siddharth Kumar
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Matthew Andoniadis
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Ali Solhpour
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Salman Asghar
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Madison Fangman
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Rani Ashouri
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States.,Departments of Psychiatry, Pharmaceutics, Psychology, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, United States
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16
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Serrano E, López-Rueda A, Moreno J, Rodríguez A, Llull L, Zwanzger C, Oleaga L, Amaro S. The new Hematoma Maturity Score is highly associated with poor clinical outcome in spontaneous intracerebral hemorrhage. Eur Radiol 2021; 32:290-299. [PMID: 34148109 DOI: 10.1007/s00330-021-08085-4] [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] [Received: 01/10/2021] [Revised: 04/06/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the new combined indicators on noncontrast computed tomography (NCCT) to predict functional outcome at discharge, compared to previously individual radiological NCCT signs. METHODS Patients with spontaneous intracerebral hemorrhage (ICH) who underwent baseline CT scan were retrospectively analyzed. Black hole (BH) sign, blend sign (BS), island sign (IS), swirl sign (SwS), Barras classification, any hypodensity, any irregularity, and two combined novel indicators-Combined Barras Total Score (CBTS) and Hematoma Maturity Score-were assessed independently by two radiologists blinded to clinical information. Patients were trichotomized depending on the disability or dependency at discharge according to the Modified Rankin Scale (mRS): no symptoms or no significant/mild disability (mRS 0-2); moderate or severe disability (mRS 3-5); and mortality (mRS 6). RESULTS One hundred fourteen patients with spontaneous ICH confirmed by NCCT were included in the analysis. Multivariable statistical analysis was adjusted for anticoagulation, hematoma volume, ventricular expansion, hypertension, blood glucose level at admission, age, and history of atrial fibrillation and demonstrated that any hypodensity (OR 4.768, p 0.006), any irregularity (OR 4.768, p 0.006), CBTS ≥ 4 (OR 3.205, p 0.025), and the new Hematoma Maturity Score (Immature) (OR 5.872, p 0.006) are independent predictors of functional outcome at discharge. CONCLUSIONS The new concept of the Hematoma Maturity Score was the radiological sign on NCCT with the highest impact on clinical outcome in comparison with the rest of the evaluated radiological signs. KEY POINTS • This is the first manuscript where density and shape characteristics of the ICH had been evaluated together and integrated in a new Hematoma Maturity Score. • The new Hematoma Maturity Score is the radiological sign on NCCT with the highest impact on clinical outcome at discharge.
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Affiliation(s)
- Elena Serrano
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Javier Moreno
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Laura Llull
- Department of Neurology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Laura Oleaga
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Sergi Amaro
- Department of Neurology, Hospital Clínic Barcelona, Barcelona, Spain
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17
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Yang X, Zhu Y, Zhang L, Wang L, Mao Y, Li Y, Luo J, Wu G. The initial CT blend sign is not associated with poor patient outcomes after stereotactic minimally invasive surgery. BMC Neurol 2021; 21:160. [PMID: 33858371 PMCID: PMC8048306 DOI: 10.1186/s12883-021-02181-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background The initial CT blend sign is an imaging marker that has been used to predict haematoma expansion and poor outcomes in patients with small-volume intracerebral haemorrhage (ICH). However, the association of the blend sign with the outcomes of patients undergoing surgery remains unclear. The present study aimed to retrospectively evaluate the influence of the initial CT blend sign on short-term outcomes in patients with hypertensive ICH after stereotactic minimally invasive surgery (sMIS). Methods We enrolled 242 patients with spontaneous ICH. The patients were assigned to the blend sign group (91 patients) or non-blend sign (control) group (151 patients) based on the initial CT features. The NIHSS, GCS and mRS were used to assess the effects of sMIS. The rates of severe pulmonary infection and cardiac complications were also compared between the two groups. Results Statistically significant differences in the NIHSS and GCS scores were not observed between the blend sign group and the control group. No significant differences in the proportion of patients with good outcomes during the follow-up period were observed between the two groups. A higher rate of re-haemorrhage was noted in the blend sign group. Significant differences in the rates of severe pulmonary infection and cardiac complications were not observed between the two groups. Conclusions The initial CT blend sign is not associated with poor outcomes in patients with hypertensive ICH after sMIS. ICH patients with the CT blend sign should undergo sMIS if they are suitable candidates for surgery.
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Affiliation(s)
- Xu Yang
- Emergency Department of Affiliated Hospital, Guizhou Medical University, No. 28, Guiyijie Road, Guiyang City, 550004, Guizhou Province, People's Republic of China
| | - Yan Zhu
- Department of Neurological Rehabilitation, Shanghai Second Rehabilitation Hospital, No. 25, Lane 860, Changjiang Road, Songnan Town, Baoshan District, Shanghai, 200441, People's Republic of China
| | - Linshan Zhang
- Emergency Department of Affiliated Hospital, Guizhou Medical University, No. 28, Guiyijie Road, Guiyang City, 550004, Guizhou Province, People's Republic of China
| | - Likun Wang
- Emergency Department of Affiliated Hospital, Guizhou Medical University, No. 28, Guiyijie Road, Guiyang City, 550004, Guizhou Province, People's Republic of China.
| | - Yuanhong Mao
- Emergency Department of Affiliated Hospital, Guizhou Medical University, No. 28, Guiyijie Road, Guiyang City, 550004, Guizhou Province, People's Republic of China
| | - Yinghui Li
- Emergency Department of Affiliated Hospital, Guizhou Medical University, No. 28, Guiyijie Road, Guiyang City, 550004, Guizhou Province, People's Republic of China
| | - Jinbiao Luo
- Department of Neurosurgery, Guangzhou First Peoples' Hospital, No. 1, Panfu Road, Guangzhou City, 510000, Guangdong Province, People's Republic of China.
| | - Guofeng Wu
- Department of Neurological Rehabilitation, Shanghai Second Rehabilitation Hospital, No. 25, Lane 860, Changjiang Road, Songnan Town, Baoshan District, Shanghai, 200441, People's Republic of China.
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18
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Hines K, Mouchtouris N, Al Saiegh F, Hafazalla K, Mazza J, Phan P, Gooch MR, Tjoumakaris S, Rosenwasser RH, Jabbour PM. Prediction of hematoma expansion in spontaneous intracerebral hemorrhage: Our institutional experience. J Clin Neurosci 2021; 86:271-275. [PMID: 33775341 DOI: 10.1016/j.jocn.2021.01.046] [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] [Received: 10/11/2020] [Revised: 12/30/2020] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (sICH) is a disease process with high morbidity and mortality. In particular, hematoma expansion (HE) is a feared complication of sICH. With 15-40% of patients experiencing HE, it has become increasingly important to predict which sICH will remain stable and which will expand. OBJECTIVE With new treatment options being developed, it is becoming increasingly important to be able to predict which hemorrhages are at high versus low risk for expansion. The authors of this study hope to reexamine variables associated with hematoma expansion in hopes of generating newer data on risk factors for expansion. METHODS A retrospective analysis identified 334 patients who presented with sICH. The primary outcome was HE on follow up head CT. HE was defined as a greater than 33% increase or an absolute increase in 6 mL or more in overall volume between the two sets of CT images. Analysis was performed using unpaired t-test, Chi-square, and Fisher's exact tests, as appropriate. RESULTS Of the 334 patients, 247 (74.0%) did not experience an expansion of their ICH while 87 (26.0%) did. Multivariable logistic regression was performed demonstrating ICH score of 3 or greater (4.76 (95% CI 2.60-8.72, p < 0.001) , cortical location of the sICH (1.77 (95% CI 1.03-3.04, p = 0.038), and presence of a fluid level (6.46 (95% CI 2.28-18.3, p < 0.001) as significant predictors of HE. CONCLUSIONS Our study found that fluid-fluid levels on non-contrast CT, an ICH score 3 or greater, and lobar sICH were all more likely to expand.
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Affiliation(s)
- Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Fadi Al Saiegh
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Karim Hafazalla
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Jacob Mazza
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Phillip Phan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - M Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Pascal M Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
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19
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Adatia K, Newcombe VFJ, Menon DK. Contusion Progression Following Traumatic Brain Injury: A Review of Clinical and Radiological Predictors, and Influence on Outcome. Neurocrit Care 2021; 34:312-324. [PMID: 32462411 PMCID: PMC7253145 DOI: 10.1007/s12028-020-00994-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Secondary injuries remain an important cause of the morbidity and mortality associated with traumatic brain injury (TBI). Progression of cerebral contusions occurs in up to 75% of patients with TBI, and this contributes to subsequent clinical deterioration and requirement for surgical intervention. Despite this, the role of early clinical and radiological factors in predicting contusion progression remains relatively poorly defined due to studies investigating progression of all types of hemorrhagic injuries as a combined cohort. In this review, we summarize data from recent studies on factors which predict contusion progression, and the effect of contusion progression on clinical outcomes.
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Affiliation(s)
- Krishma Adatia
- Division of Anaesthesia, University of Cambridge, Cambridge, UK.
| | | | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
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20
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Shakya MR, Fu F, Zhang M, Shan Y, Yu F, Sun S, Lu J. Comparison of Black Hole Sign, Satellite Sign, and Iodine Sign to Predict Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3919710. [PMID: 33604373 PMCID: PMC7870314 DOI: 10.1155/2021/3919710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/02/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To discretely and collectively compare black hole sign (BHS) and satellite sign (SS) with recently introduced gemstone spectral imaging-based iodine sign (IS) for predicting hematoma expansion (HE) in spontaneous intracerebral hemorrhage (SICH). METHODS This retrospective study includes 90 patients from 2017 to 2019 who underwent both spectral computed tomography angiography (CTA) as well as noncontrast computed tomography (NCCT) within 6 hours of SICH onset along with subsequent follow-up NCCT scanned within 24 hours. We named the presence of any of BHS or SS as any NCCT sign. Two independent reviewers analyzed all the HE predicting signs. Receiver-operator characteristic curve analysis and logistic regression were performed to compare the predictive performance of HE. RESULTS A total of 61 patients had HE, out of which IS was seen in 78.7% (48/61) while BHS and SS were seen in 47.5% (29/61) and 41% (25/61), respectively. The area under the curve for BHS, SS, and IS was 63.4%, 67%, and 82.4%, respectively, while for any NCCT sign was 71.5%. There was no significant difference between IS and any NCCT sign (P = 0.108). Multivariate analysis showed IS (odds ratio 68.24; 95% CI 11.76-396.00; P < 0.001) and any NCCT sign (odds ratio 19.49; 95% CI 3.99-95.25; P < 0.001) were independent predictors of HE whereas BHS (odds ratio 0.34; 95% CI 0.01-38.50; P = 0.534) and SS (odds ratio 4.54; 95% CI 0.54-38.50; P = 0.165) had no significance. CONCLUSION The predictive accuracy of any NCCT sign was better than that of sole BHS and SS. Both any NCCT sign and IS were independent predictors of HE. Although IS had higher predictive accuracy, any NCCT sign may still be regarded as a fair predictor of HE when CTA is not available.
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Affiliation(s)
- Milind Ratna Shakya
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Fan Fu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Miao Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Yi Shan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Fan Yu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
| | - Shengjun Sun
- Neuroradiology Department, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119 Nansihuanxilu, Fengtai District, Beijing, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
- Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China
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21
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Mosconi MG, Paciaroni M, Agnelli G, Marzano M, Alberti A, Venti M, Acciarresi M, Ruffini F, Caso V. SMASH-U classification: a tool for aetiology-oriented management of patients with acute haemorrhagic stroke. Intern Emerg Med 2021; 16:109-114. [PMID: 32266689 DOI: 10.1007/s11739-020-02330-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
Intracerebral haemorrhage (ICH) is responsible for disproportionately high morbidity and mortality rates. The most used ICH classification system is based on the anatomical site. We used SMASH-U, an aetiological based classification system for ICH by predefined criteria: structural vascular lesions (S), medication (M), amyloid angiopathy (A), systemic disease (S), hypertension (H), or undetermined (U). We aimed to correlate SMASH-U classification of our patients to the intra-hospital mortality rates. We performed a single centre retrospective study at the Santa Maria Della Misericordia Hospital, Perugia (Italy) including consecutive patients between January 2009 and July 2017 assigned with 431 ICD-9 (International Classification of Diseases-9). We classified the included patients using SMASH-U criteria, and we analysed the association between SMASH-U aetiology and ICH risk factors to the outcome defined as intra-hospital mortality, using multivariable logistic regression analysis. The higher intra-hospital mortality rate was detected in the systemic disease (36.1%), medication (31.5%), and undetermined (29.4%) groups. At multivariable analysis, medication and systemic disease groups resulted associated with the outcome (odds ratio 3.47; 95% CI 1.15-10.46; P = 0.02 and 3.64; 95% CI 1.47-9.01; P = 0.005, respectively). Furthermore, age and high NIHSS at admission resulted significantly associated with intra-hospital mortality (odds ratio 1.01; 95% CI 1-1.03; P = 0.04 and 1.12; 95% CI 1.03-1.22; P = 0.008, respectively). In our retrospective study, the aetiology-oriented classification system SMASH-U showed to be potentially predictive of intra-hospital mortality of acute haemorrhagic stroke patients and it may support clinicians in the acute ICH management.
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Affiliation(s)
- Maria Giulia Mosconi
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy.
| | - Maurizio Paciaroni
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Martino Marzano
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Andrea Alberti
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Monica Acciarresi
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
| | - Fabrizio Ruffini
- "Ufficio Controllo di Gestione e Sistema Informativo", Santa Maria della Misericordia Hospital, Piazzale Menghini 1, Perugia, 06129, Italy
| | - Valeria Caso
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
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22
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Zhang C, Ge H, Zhong J, Yin Y, Fang X, Zou Y, Feng H, Hu R. Development and validation of a nomogram for predicting hematoma expansion in intracerebral hemorrhage. J Clin Neurosci 2020; 82:99-104. [PMID: 33317748 DOI: 10.1016/j.jocn.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE To develop and validate a clinical nomogram for individualized predicting hematoma expansion (HE) in patients with Intracerebral Hemorrhage (ICH). METHODS A total of 1025 patients with ICH were retrospectively enrolled in the development cohort between 2010 and 2016. We identified and integrated significant factors for HE to build a nomogram. The model was subjected to validation with a separate cohort of 397 patients from the 2017-2019. The predictive accuracy and discriminative ability were measured by concordance index (C-index). The primary outcome was HE, defined as hematoma growth more than 6 mL or 33% increase in the volume. RESULTS A total of 1025 patients were included for univariable analysis. HE occurred in 180 patients (17.6%). The time to initial CT (≤6h vs. >6 h; p = 0.001), NIHSS score (0-4 vs. 5-14 vs. ≥15; p = 0.031), CTA spot sign (yes vs. no vs. absent; p = 0.018), hypodensities (p = 0.000), blend sign (p = 0.005), and INR (<1.2 vs. ≥1.2; p = 0.009) were identified and entered into the nomogram. The calibration curves for probability of HE showed optimal agreement between nomogram prediction and actual observation. The C-index was 0.751. The validation cohort consisted of 397 patients and HE occurred in 78 patients (19.6%). The C-index was 0.743. CONCLUSIONS We developed and validated a nomogram that can individually predict HE for ICH in Chinese populations. This practical prognostic nomogram may help clinicians make decision of clinical practice and design of clinical studies.
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Affiliation(s)
- Chao Zhang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hongfei Ge
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jun Zhong
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yi Yin
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xuanyu Fang
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yongjie Zou
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Rong Hu
- Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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Lv XN, Li Q. Imaging predictors for hematoma expansion in patients with intracerebral hemorrhage: A current review. BRAIN HEMORRHAGES 2020. [DOI: 10.1016/j.hest.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Wang L, Zhang L, Mao Y, Li Y, Wu G, Li Q. Regular-Shaped Hematomas Predict a Favorable Outcome in Patients with Hypertensive Intracerebral Hemorrhage Following Stereotactic Minimally Invasive Surgery. Neurocrit Care 2020; 34:259-270. [PMID: 32462410 DOI: 10.1007/s12028-020-00996-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stereotactic minimally invasive surgery (sMIS) has been used in the treatment of intracerebral hemorrhage (ICH) in recent years and has obtained promising results. However, the outcomes of patients are associated with many factors. The aim of the present study was to retrospectively observe the relationship between hematoma shape features and the outcome of patients with spontaneous ICH following sMIS. METHODS One hundred eighty-three patients with hypertensive ICH who underwent sMIS were enrolled. Based on hematoma shape features, the patients were assigned to a regular-shaped hematoma group (RSH group, including 121 patients) or an irregular-shaped hematoma group (ISH group, including 62 patients). The Glasgow Coma Scale (GCS) score and the National Institutes of Health Stroke Scale (NIHSS) score were assessed on admission and at 1 week and 2 weeks after surgery. The rates of severe pulmonary infection, cardiac complications, and postoperative rebleeding during the hospital stay were also recorded for comparison. The functional outcome assessed by using the modified Rankin scale score was determined at discharge. A multivariate logistic regression analysis was performed for predictors of good outcome in patients with ICH who underwent sMIS. A receiver operating characteristic curve was also used to confirm the results. RESULTS Compared to the ISH group, the RSH group showed increased median GCS scores at one week and two weeks after surgery. The RSH group showed significantly decreased NIHSS scores at one week and two weeks after surgery compared with the ISH group at the same time point. Significant differences in the GCS score and the NIHSS score at 1 week (P < 0.05) and 2 weeks (P < 0.05) after surgery were observed between the RSH group and the ISH group. The RSH group showed lower rates of severe pulmonary infection, heart failure, and postoperative rehemorrhage than the ISH group (P < 0.05). Of the total patients with good outcomes, the RSH group accounted for 84.6%, and just 15.4% were from the ISH group. The multivariate logistic regression analysis demonstrated that regular-shaped hematoma (P < 0.0001) was an independent predictor of good outcome. The postoperative residual hematoma volume (P < 0.05) predicted a poor outcome. The sensitivity, specificity, and positive and negative predictive values of regular-shaped hematomas for the prediction of a favorable outcome in patients were 0.667, 0.846, 0.917, and 0.542, respectively. Additionally, the Youden index was 0.513. CONCLUSIONS Patients with regular-shaped hematomas exhibited more favorable outcomes. Irregular-shaped hematomas and postoperative residual hematoma volume predicted a poor outcome in patients with ICH following sMIS.
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Affiliation(s)
- Likun Wang
- Emergency Department, Guizhou Province, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyijie Road, Liuguangmen, Guiyang City, 550004, People's Republic of China
| | - Linshan Zhang
- Emergency Department, Guizhou Province, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyijie Road, Liuguangmen, Guiyang City, 550004, People's Republic of China
| | - Yuanhong Mao
- Emergency Department, Guizhou Province, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyijie Road, Liuguangmen, Guiyang City, 550004, People's Republic of China
| | - Yinghui Li
- Emergency Department, Guizhou Province, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyijie Road, Liuguangmen, Guiyang City, 550004, People's Republic of China
| | - Guofeng Wu
- Emergency Department, Guizhou Province, The Affiliated Hospital of Guizhou Medical University, No. 28, Guiyijie Road, Liuguangmen, Guiyang City, 550004, People's Republic of China.
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing City, People's Republic of China.
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Zhang M, Chen J, Zhan C, Liu J, Chen Q, Xia T, Zhang T, Zhu D, Chen C, Yang Y. Blend Sign Is a Strong Predictor of the Extent of Early Hematoma Expansion in Spontaneous Intracerebral Hemorrhage. Front Neurol 2020; 11:334. [PMID: 32508731 PMCID: PMC7248383 DOI: 10.3389/fneur.2020.00334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/07/2020] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose: It is unclear which imaging marker is optimal for predicting the extent of hematoma expansion (EHE). We aimed to compare the usefulness of the blend sign (BS) with that of other non-contrast computed tomography (NCCT) markers for predicting the EHE in patients with spontaneous intracerebral hemorrhage (sICH). Methods: Patients with sICH admitted to our Neurology Emergency Department between September 2013 and January 2019 were enrolled. The EHE was calculated as the absolute increase in hematoma volume between baseline and follow-up CT (within 72 h). The EHE was categorized into four groups: "no growth," "minimal change" (≤5.1 ml), "moderate change" (5.1-12.5 ml), and "massive change" (>12.5 ml). Univariate and multivariate analyses were performed to investigate the relationship between the NCCT markers [BS, black hole sign (BHS), satellite sign, and island sign] and the EHE. Results: A total of 1,111 sICH patients were included (median age: 60 years; 66.5% males). Multiple linear regression analysis showed that the presence of the BS and BHS was independently associated with the EHE, after adjusting for confounders (P < 0.001 and P = 0.003, respectively). The presence of the BS and BHS was positively correlated with growth category (r = 0.285 and r = 0.199, both Ps < 0.001). The BS demonstrated a better predictive performance for the EHE than did the BHS [area under the curve (AUC): 0.67 vs. 0.57; both Ps < 0.001]. Conclusions: In patients with acute sICH, the BS showed a better performance in predicting the EHE compared with other NCCT markers. This imaging marker may help identify patients at a high risk of significant hematoma expansion and may facilitate its early management.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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The Role of Serum Calcium Level in Intracerebral Hemorrhage Hematoma Expansion: Is There Any? Neurocrit Care 2020; 31:188-195. [PMID: 29951959 DOI: 10.1007/s12028-018-0564-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, with a high rate of mortality and morbidity. Even with the best current medical or surgical interventions, outcomes remain poor. The location and initial hematoma volume are strong predictors of mortality. Hematoma expansion (HE) is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for HE have been identified, including baseline ICH volume, anticoagulation, and computed tomography angiography spot signs. Recent studies have shown the correlation of serum calcium (Ca++) levels on admission with HE. Low serum Ca++ level has been associated with larger hematoma volume at the time of presentation, HE, and worse outcome. Although the causal and mechanistic links between low serum Ca++ level and HE are not well understood, several mechanisms have been proposed including coagulopathy, platelet dysfunction, and higher blood pressure (BP) in the context of low serum Ca++ level. However, low serum Ca++ level might be only a biomarker of the adaptive response due to acute inflammatory response following acute ICH. The purpose of the current review is to discuss the evidence regarding the possible role of low serum Ca++ level on HE in acute ICH.
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Inter- and Intrarater Agreement of Spot Sign and Noncontrast CT Markers for Early Intracerebral Hemorrhage Expansion. J Clin Med 2020; 9:jcm9041020. [PMID: 32260409 PMCID: PMC7231301 DOI: 10.3390/jcm9041020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background: The aim of this study was to assess the inter- and intrarater reliability of noncontrast CT (NCCT) markers [Black Hole Sign (BH), Blend Sign (BS), Island Sign (IS), and Hypodensities (HD)] and Spot Sign (SS) on CTA in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Patients with spontaneous ICH at three German tertiary stroke centers were retrospectively included. Each CT scan was rated for four NCCT markers and SS on CTA by two radiology residents. Raters were blind to all demographic and outcome data. Inter- and intrarater agreement was determined by Cohen’s kappa (κ) coefficient and percentage of agreement. Results: Interrater agreement was excellent in 473 included patients, ranging from 96% to 99%. Interrater κ ranged from 0.85 (95% CI [0.78–0.91]) to 0.97 (95% CI [0.94–0.99]) for NCCT markers and 0.93 (95% CI [0.88–0.98]) for SS, all p-values < 0.001. Intrarrater agreement ranged from 96% to 100%, with κ ranging from 0.85 (95% CI [0.78–0.91]) to 1.00 (95% CI [0.10–0.85]) for NCCT markers and 0.96 (95% CI [0.92–1.00]) for SS, all p-values < 0.001. Conclusions: NCCT imaging findings and SS on CTA have good-to-excellent inter- and intrarater reliabilities, with the highest agreement for BH and SS.
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Abbas M, Haddad E, Hamer M, Nowrangi D, Zhang J, Pearce WJ, Tang J, Obenaus A. Acute Treatment With Gleevec Does Not Promote Early Vascular Recovery Following Intracerebral Hemorrhage in Adult Male Rats. Front Neurosci 2020; 14:46. [PMID: 32116501 PMCID: PMC7010856 DOI: 10.3389/fnins.2020.00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022] Open
Abstract
Intracerebral hemorrhage (ICH) remains one of the most debilitating types of stroke and is characterized by a sudden bleeding from a ruptured blood vessel. ICH often results in high mortality and in survivors, permanent disability. Most studies have focused on neuroprotective strategies designed to minimize secondary consequences and prevent further pathology. Lacking is an understanding of how ICH acutely affects cerebrovascular components and their response to therapeutic interventions. We hypothesized that ICH alters cortical vessel complexity in the parenchyma adjacent to site of the initial vascular disruption and that vascular abnormalities would be mitigated by administration of the PDGFR inhibitor, Imatinib mesylate (Gleevec). Briefly, ICH was induced in male adult rats by injection of collagenase into basal ganglia, followed by Gleevec administration (60 mg/kg) 1 h after injury. Rats were then perfused using vessel painting methodology (Salehi et al., 2018b) to stain whole brain vascular networks at 1 day post-ICH. Axial and coronal wide field fluorescence microscopy was performed. Analyses for vascular features were undertaken and fractal analysis for vascular complexity. Data were collected from four groups of rats: Sham + Vehicle; Sham + Gleevec; ICH + Vehicle; ICH + Gleevec. Microscopy revealed that cortical vessels in both ipsi- and contralateral hemispheres exhibited significantly reduced density and branching by 22 and 34%, respectively. Fractal measures confirmed reduced complexity as well. Gleevec treatment further reduced vascular parameters, including reductions in vessel density in tissues adjacent to the ICH. The reductions in brain wide vascular networks after Gleevec in the current study after ICH is contrasted by previous reports of improved behavioral outcomes and decreased lCH lesion volumes Reductions in the vascular network after Gleevec may be involved in long-term repair mechanisms by pruning injured vessels to ultimately promote new vessel growth.
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Affiliation(s)
- Mohammed Abbas
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, United States
| | - Elizabeth Haddad
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States
| | - Mary Hamer
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States
| | - Derek Nowrangi
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
| | - John Zhang
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
- Department of Anesthesiology, Loma Linda University, Loma Linda, CA, United States
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, United States
| | - William J. Pearce
- Center for Perinatal Biology, Loma Linda University, Loma Linda, CA, United States
| | - Jiping Tang
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
| | - Andre Obenaus
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, United States
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States
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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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Kim CH, Lee SW, Kim YH, Sung SK, Son DW, Song GS. Predictors of Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage Treated with Rapid Administration of Antifibrinolytic Agents and Strict Conservative Management. Korean J Neurotrauma 2019; 15:126-134. [PMID: 31720266 PMCID: PMC6826086 DOI: 10.13004/kjnt.2019.15.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small blood vessels and other health problems. In ICH patients, hematoma enlargement is the most critical risk factor for poor outcomes. Tranexamic acid, an anti-fibrinolytic agent, has been used to reduce hematoma expansion. We analyzed the risk factors for hematoma expansion in ICH patients and compared the predictability of hematoma expansion in ICH patients with the use of tranexamic acid. Methods We performed retrospective analysis of ICH patients who underwent follow-up computed tomography scans from October 2008 to October 2018. Of the 329 included patients, 67 who received tranexamic acid and 262 who did not receive tranexamic acid were compared. We also analyzed the risk factors of 45 and 284 patients who did and did not experience hematoma expansion, respectively. Results Hematoma expansion was observed in 7 (10.4%) of 67 patients in the tranexamic acid group and 38 (14.5%) of the 262 patients who did not receive tranexamic acid. There was no statistically significant difference between patients who did and did not received tranexamic acid (p=0.389). In the multivariate logistic regression analysis of risk factors for hematoma expansion, spot sign and a maximal diameter of 40 mm were identified as risk factors. Conclusion We could not confirm the effect of tranexamic acid on hematoma expansion in ICH patients. Spot sign and the maximal diameter of hematomas were confirmed as risk factors of hematoma expansion. If the maximal diameter is greater than 40 mm, the hematoma should be closely monitored.
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Affiliation(s)
- Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Association between neutrophil to lymphocyte ratio and blood glucose level at admission in patients with spontaneous intracerebral hemorrhage. Sci Rep 2019; 9:15623. [PMID: 31666624 PMCID: PMC6821865 DOI: 10.1038/s41598-019-52214-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
Previous studies indicated that both inflammatory responses and hyperglycemia are involved in the similar pathophysiological mechanisms after onset of intracerebral hemorrhage (ICH). However the relationship between hyperglycemia and inflammation remains unknown. We aim to evaluate the associations of hyperglycemia with inflammation and neutrophil to lymphocyte ratio (NLR) in patients with ICH. Patients with acute ICH were retrospectively enrolled. Clinical characteristics and imaging features were obtained. The associations between outcome and laboratory biomarkers were assessed by multivariable logistic regression analysis. Spearman analysis and multiple linear regression analysis were performed to estimate the association of NLR and serum glucose. 175 patients were enrolled. Poor outcome occurred in 86 patients at 30 days. Elevated blood glucose level (BGL) and NLR were strongly associated with outcome in patients with ICH. Moreover, combined NLR-BGL exhibited a better predictive accuracy compared with the peripheral leukocyte counts. Furthermore, there was a robust association between BGL and NLR. We first demonstrated both of NLR and BGL were independently associated with each other. Our results indicate that inflammatory responses and the pathological process of hyperglycemia may influence each other by several complex pathological mechanisms and have a mutual promoting effect to secondary brain injury.
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Wajngarten M, Silva GS. Hypertension and Stroke: Update on Treatment. Eur Cardiol 2019; 14:111-115. [PMID: 31360232 PMCID: PMC6659031 DOI: 10.15420/ecr.2019.11.1] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Hypertension is the most prevalent risk factor for stroke. Stroke causes and haemodynamic consequences are heterogeneous which makes the management of blood pressure in stroke patients complex requiring an accurate diagnosis and precise definition of therapeutic goals. In this article, the authors provide an updated review on the management of arterial hypertension to prevent the first episode and the recurrence. They also present a discussion on blood pressure management in hypertensive urgencies and emergencies, especially in the acute phase of hypertensive encephalopathy, ischaemic stroke and haemorrhagic stroke.
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Affiliation(s)
| | - Gisele Sampaio Silva
- Neurology and Neurosurgery Department, Federal University of São PauloBrazil
- Academic Research Organization, Hospital Israelita Albert EinsteinSão Paulo, Brazil
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Hussein O, Sawalha K, Fritz J, Abd Elazim A, Hamed M, Wei L, Mainali S. The Significance of Contrast Density of the Computed Tomography-Angiographic Spot Sign and its Correlation with Hematoma Expansion. J Stroke Cerebrovasc Dis 2019; 28:1474-1482. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/24/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022] Open
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Zhang F, Zhang S, Tao C, Yang Z, Li X, You C, Xin T, Yang M. Association between serum glucose level and spot sign in intracerebral hemorrhage. Medicine (Baltimore) 2019; 98:e14748. [PMID: 30882643 PMCID: PMC6426545 DOI: 10.1097/md.0000000000014748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hyperglycemia was proved to cause neuron death in both animal experiments and poor outcome of hemorrhage patients, but the predictive ability of admission blood glucose level for early hematoma growth in patients with intracranial hemorrhage (ICH) is still controversial. Spot sign is a well-established imaging predictor for early hematoma growth, implying active microvascular bleeding. Here, we aim to assess associations between admission serum glucose and early hematoma expansion in ICH patients, as well as spot sign.We retrospectively reviewed all the patients with ICH from January 2017 to March 2018 in West China Hospital, Sichuan University. Admission blood glucose, clinical variables, radiological characteristics, and laboratorial parameters were obtained from medical record. According to computed tomography (CT) and computed tomography angiography (CTA) scan results, hematoma expansion and spot sign were identified by 2 experienced neuroradiologists. Multivariate logistic regression analyses were employed to adjust the associations of hematoma expansion and spot sign with other clinical parameters.Around 42 patients exhibited early hematoma expansions and 26 exhibited spot signs over 138 enrolled patients. The average level of admission blood glucose was 7.55 mmol/L. Multivariate logistic regression analyses revealed that Glasgow Coma Scale (GCS) score on admission, hematoma volume, spot sign, and hyperglycemia were associated with hematoma expansion, whereas admission serum glucose and hematoma size were only associated with spot sign, respectively.Admission blood glucose level is correlated with hematoma growth and incidence of spot sign. These results indicated that hyperglycemia probably plays a critical role in the pathological process of the active bleeding. Further studies should be drawn urgently to understand the potential molecular mechanism of systemic hyperglycemia in affecting prognosis of patients with ICH.
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Affiliation(s)
- Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Pathology, Case Western Reserve University, Ohio
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zijia Yang
- Department of Neurosurgery, Chengdu First People's Hospital, Chengdu
| | - Xi Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Xin
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Mu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology and Neurosurgery
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
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Naldi A, Pivetta E, Coppo L, Cantello R, Comi C, Stecco A, Cerrato P, Lesmeister M, Lochner P. Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage. J Neuroimaging 2019; 29:394-399. [PMID: 30714259 DOI: 10.1111/jon.12604] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/21/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Evaluation of the diagnostic accuracy of optic nerve sheath diameter (ONSD) and Doppler indices of central retinal arteries and veins for the detection of increased intracranial pressure (ICP) in intracerebral hemorrhage (ICH) and of the usefulness of a second assessment of these variables in the monitoring of ICH. METHODS A total of 46 acute ICH patients with (group 1, n = 25) and without (group 2, n = 21) clinical and radiological computed tomography signs of raised ICP and 40 healthy controls were recruited. The median binocular ONSD and Doppler indices of retinal vessels including resistive index (RI) and retinal venous pulsation (RVP) were compared among groups, both at admission and later during ICH monitoring. RESULTS Median binocular ONSD showed higher accuracy for the detection of increased ICP (sensitivity and specificity 100%), while Doppler indices were less accurate (sensitivity 48% and specificity 95% for RI; 80% and 62% for RVP). In ICH patients, ONSD was significantly elevated in group 1 both at admission (6.40 mm [interquartile range [IQR] = .70] vs. 4.70 [.40]) and at control time (6.00 [.55] vs. 4.55 [.40]; P < .01), as well as RI (.79 [.11] vs. .77 [.03] and .80 [.06] vs. .75 [.35]; P = .01). RVP was significantly increased in group 1 only at admission (3.20 cm/s [1.05] vs. 2.00 [1.55], P = .02). CONCLUSIONS Median binocular ONSD evaluation showed higher accuracy for the estimation of elevated ICP compared with Doppler indices of retinal vessels. The ONSD enlargement detected in the early phase of ICH persists at control time.
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Affiliation(s)
- Andrea Naldi
- Stroke Unit, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Emanuele Pivetta
- Cancer Epidemiology Unit and CPO Unit, and Division of Emergency Medicine and High Dependency Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Coppo
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Roberto Cantello
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessandro Stecco
- Neuroradiology Unit, University of Piemonte Orientale, Novara, Italy
| | - Paolo Cerrato
- Stroke Unit, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Martin Lesmeister
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Dong J, Yang X, Xiang J, Dong Q, Tang Y, Chu H. Hypodensities detected at 1.5–3 h after intracerebral hemorrhage better predicts secondary neurological deterioration. J Neurol Sci 2019; 396:219-224. [DOI: 10.1016/j.jns.2018.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/01/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Ianosi B, Gaasch M, Rass V, Huber L, Hackl W, Kofler M, Schiefecker AJ, Addis A, Beer R, Rhomberg P, Pfausler B, Thomé C, Ammenwerth E, Helbok R. Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage. Eur J Neurol 2018; 26:333-341. [DOI: 10.1111/ene.13830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- B. Ianosi
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - M. Gaasch
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - V. Rass
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - L. Huber
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - W. Hackl
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - M. Kofler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. J. Schiefecker
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. Addis
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - R. Beer
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - P. Rhomberg
- Department of Neuroradiology; Medical University of Innsbruck; Innsbruck
| | - B. Pfausler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - C. Thomé
- Department of Neurosurgery; Medical University of Innsbruck; Innsbruck Austria
| | - E. Ammenwerth
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - R. Helbok
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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Island Sign Predicts Long-Term Poor Outcome and Mortality in Patients with Intracerebral Hemorrhage. World Neurosurg 2018; 120:e304-e312. [DOI: 10.1016/j.wneu.2018.08.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 02/06/2023]
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Zhang F, Zhang S, Tao C, Yang Z, You C, Yang M. The comparative study of island sign and the spot sign in predicting short-term prognosis of patients with intracerebral hemorrhage. J Neurol Sci 2018; 396:133-139. [PMID: 30471632 DOI: 10.1016/j.jns.2018.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/13/2018] [Accepted: 11/16/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES It is well known that early hematoma expansion is associated with short-term prognosis of patients with intracranial hemorrhage (ICH). And spot sign is recognized as a reliable computed tomography angiography (CTA) predictor for early hematoma expansion. Recently, island sign is also reported as a novel computed tomography (CT) predictor for early hematoma growth. Here, we compared the predictive abilities of these two signs for short-term outcomes of ICH patients. PATIENTS AND METHODS All the ICH patients were retrospectively identified. Clinical characteristics and radiological parameters were obtained from electronic medical records. Hematoma expansion, spot sign and island sign were assessed by two senior neurologists according to the initial and follow-up CT scans. 3-months prognoses were estimated according to Glasgow outcome scale (GOS). Multivariate logistic regression analyses were employed to explore the associations of short-term prognosis on island sign, spot sign and other clinical variables. RESULTS There were 283 ICH patients included. 113 of them presented with early hematoma expansions. 66 of them exhibited island sign, while spot sign occurred in 85 patients. Univariate analyses demonstrated that GCS score at admission (OR: 0.464, 95%CI: 0.395-0.547), hematoma volume (OR:1.062, 95%CI: 1.041-1.083), interventricular extension(OR:9.528, 95%CI: 3.915-23.187), island sign (OR: 4.595, 95%CI: 2.404-8.784) and spot sign (OR: 4.052, 95%CI: 2.297-7.147) were correlated with 3-months morbidity. Moreover, multivariate logistic regression analyses further revealed that both spot sign (OR: 3.413, 95%CI: 1.570-7.422) and island sign (OR: 7.564, 95%CI: 2.969-19.273) were strongly associated with 3-months poor outcome and have comparable predictive values (AUC: 0.636 vs. 0.622, P = .58). However, spot sign exhibited a superior predictive ability for 3-months mortality compared to island sign (OR: 2.713, 95%CI: 1.570-4.217 vs. OR: 2.362, 95%CI: 1.238-3.899, AUC: 0.700 vs. 0.603, P < .01). CONCLUSIONS Island sign is not just a convenient and reliable predictor for short-term prognosis of ICH patients, but also could be used as an indicator for accurate diagnosis and aggressive treatment.
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Affiliation(s)
- Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Pathology, Case Western Reserve University, OH, USA
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zijia Yang
- Department of Neurosurgery, Chengdu First People's Hospital, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada.
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Zhang F, Qian J, Tao C, Wang Y, Lin S, You C, Yang M. Neutrophil to lymphocyte ratio predicts island sign in patients with intracranial hemorrhage. Medicine (Baltimore) 2018; 97:e13057. [PMID: 30383680 PMCID: PMC6221617 DOI: 10.1097/md.0000000000013057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Our previously studies indicated that inflammatory responses are involved in the hematoma expansion (HE) after intracranial hemorrhage (ICH) ictus. Here, we aim to evaluate the correlations among the ratio of neutrophil to lymphocyte ratio (NLR), HE, and island sign in patients with ICH.Patients with spontaneous ICH were retrospectively included. Clinical characteristics, imaging features, and laboratory parameters were obtained. Multivariable analysis was performed to evaluate the association of NLR with HE or island sign. Receiver-operator analysis was also used to estimate their predictive abilities for HE and its imaging features.A total of 279 patients were enrolled in present study, and 78 patients had early hematoma growth, while 43 of them exhibited island sign. Elevation of both leukocyte (odds ratio [OR] 1.136, 95% confidence interval [CI] 1.037-1.245, P < .01) and neutrophil absolute numbers (OR 1.169, 95% CI 1.065-1.284, P < .01), as well as reduction of lymphocyte counts (OR 0.052, 95% CI 0.016-0.167, P < .01) were strongly associated with the existence of island sign. Moreover, despite the predictive ability of NLR on the existence of island sign (OR 1.063, 95% CI 1.036-1.090, P < .01), it also showed the best predictive accuracy (sensitivity 76.74%, specificity 79.66%, positive predictive value 40.70%, negative predictive value 94.90%, area under the curve 0.817) by comparing with peripheral leukocyte counts.The NLR could be used as an independently marker for reflecting the island sign in patients with ICH. Our findings indicated that systemic inflammatory responses might be involved in the pathologic process of active bleeding in cerebral.
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Affiliation(s)
- Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Pathology
| | - Juan Qian
- Department of Population and Quantitative Health, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuelong Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Sen Lin
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Zhang F, Li H, Qian J, Zhang S, Tao C, You C, Yang M. Hyperglycemia Is Associated with Island Sign in Patients with Intracerebral Hemorrhage. World Neurosurg 2018; 119:e703-e709. [DOI: 10.1016/j.wneu.2018.07.251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/15/2022]
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Zhang F, Li H, Qian J, Tao C, Zheng J, You C, Yang M. Hyperglycemia Predicts Blend Sign in Patients with Intracerebral Hemorrhage. Med Sci Monit 2018; 24:6237-6244. [PMID: 30191900 PMCID: PMC6139114 DOI: 10.12659/msm.910024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Predictive values of admission blood glucose for early hematoma expansion in patients with intracranial hemorrhage (ICH) remain controversial. Blend sign is a novel image predictor for early hematoma growth that suggests presence of active bleeding. We investigated the association between hyperglycemia and blend sign in predicting early hematoma growth in ICH patients. Material/Methods All patients with intracranial hemorrhage were retrospectively reviewed. Clinical characteristics and radiological parameters were collected. Blood glucose was measured within 24 h after onset. CT scan results for hematoma expansion and blend sign were evaluated by 2 readers. Multivariate logistic regression analyses were applied to reveal the associations between hematoma growth and blend sign, as well as other variables. Results Out of 164 patients with ICH, 52 exhibited early hematoma growth and 18 of these were diagnosed with blend sign. Average blood glucose was 7.53 mmol/L among all patients. By using multivariate analyses, the time of CT scan baseline, GCS score, hematoma size, blend sign, and blood glucose were associated with hematoma expansion, whereas only hyperglycemia was associated with blend sign. Conclusions Admission hyperglycemia is associated with hematoma expansion in the presence of blend sign. These findings suggest that elevated blood glucose is a possible factor predicting continuous bleeding. Strategies to control blood glucose and ameliorate hematoma growth are urgently needed and will be investigated in our future studies.
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Affiliation(s)
- Fan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Juan Qian
- Department of Population and Quantitative Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Mu Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland).,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
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Yan F, Yi Z, Hua Y, Shen Y, Li M, Ding Y, Chandra A, Ji X, Yue W. Predictors of mortality and recurrent stroke within five years of intracerebral hemorrhage. Neurol Res 2018; 40:466-472. [PMID: 30134784 DOI: 10.1080/01616412.2018.1451266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhang Yi
- Drug Clinical Trial Institution, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Hua
- Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ankush Chandra
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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