Association between perihematomal perfusion and intracerebral hemorrhage shape

Morotti, Andrea; Busto, Giorgio; Scola, Elisa; Carlesi, Edoardo; Pasquale, Francesca Di; Casetta, Ilaria; Fainardi, Enrico

doi:10.1007/s00234-021-02709-8

Cited by 5 publications

(2 citation statements)

References 15 publications

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“…15 , 16 Although CTA spot sign and leakage sign are of high value in predicting the occurrence of E in patients with primary cerebral hemorrhage, they have shortcomings such as excessive radiation dose, high cost, and risk of allergic reaction. 13 , 17 Therefore, they cannot be used as the first choice for examination, while the blend sign is convenient and suitable for general use. 9 , 11 , 12 Hematoma density is affected by its components, specifically, hemoglobin is an important factor that determines the hematoma density on a CT scan.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram

Dai¹,

Liú²,

Li³

et al. 2023

Pak J Med Sci

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Objective: To develop and validate a radiomics-based nomogram model which aimed to predict hematoma expansion (HE) in hypertensive intracerebral hemorrhage (HICH). Methods: Patients with HICH (n=187) were included from October 2017 to March 2022 in the Yongchuan Affiliated Hospital of Chongqing Medical University. Patients were randomly divided into a training set (n=130) and a validation set (n=57) in a ratio of 7:3. The radiomic features were extracted from the regions of interest (including main hematoma, the surrounding small hematoma(s) and perihematomal edema) in the first CT scan images. The variance threshold, SelectKBest and LASSO (least absolute shrinkage and selection operator), features were selected and the radiomics signature was built. Multivariate logistic regression was used to establish a nomogram based on clinical risk factors and the Rad-score. A receiver operating characteristic (ROC) curve was used to evaluate the generalization of the models’ performance.The calibration curve and the Hosmer-Lemeshow test were used to assess the calibration of the predictive nomogram. And decision curve analysis (DCA) was used to evaluate the prediction model. Results: Thirteen radiomics features were selected to construct the radiomics signature, which has a robust association with HE. The radiomics model found that blend sign was a predictive factor of HE. The radiomics model ROC in the training set was 0.89 (95%CI 0.82-0.96) and was 0.82 (95%CI 0.60-0.93) in the validation set. The nomogram model was built using the combined prediction model based on radiomics and blend sign, and worked well in both the training set (ROC: 0.90[95%CI 0.83-0.96]) and the validation set (ROC: 0.88[95%CI 0.71-0.93]). Conclusion: The radiomic signature based on CT of HICH has high accuracy for predicting HE. The combined prediction model of radiomics and blend sign improves the prediction performance. doi: https://doi.org/10.12669/pjms.39.4.7724 How to cite this: Dai J, Liu D, Li X, Liu Y, Wang F, Yang Q. Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram. Pak J Med Sci. 2023;39(4):1149-1155. doi: https://doi.org/10.12669/pjms.39.4.7724 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram

Dai¹,

Liú²,

Li³

et al. 2023

Pak J Med Sci

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“…Other studies did not confirm the presence of perihaemorrhagic penumbra, 22 but this discrepancy may be explained by the small sample size with a minority of patients receiving a perfusion study beyond 5 days from onset. Furthermore, recent data have shown a significant association between perihematomal hypoperfusion and irregular haemorrhage shapes, 23 and while this may seem unrelated, previous evidence suggests that irregularity of haemorrhage borders on baseline CT may be an indirect biomarker of both haemorrhage immaturity (i.e., with either persisting bleeding or unsettled peripheral mass effect) and poorer outcome. 24 Similarly, the present study provides additional evidence that perihematomal hypoperfusion and its evolution over time may be an important biomarker of ICH formation and evolution pathophysiological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage

Morotti

Busto

Boulouis

et al. 2021

Eur J Clin Investigation

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Background The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). Methods A single‐centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low‐density area. Poor functional prognosis (modified Rankin Scale 3–6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. Results A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3–6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change −7.8 vs. −6.0 ml/100 g/min, p < .001, and median CBV change −0.5 vs. −0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15–1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18–2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08–5–54, p = .032). Conclusion Perihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.

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Assessing the Evolution of Intracranial Hematomas by using Animal Models: A Review of the Progress and the Challenges

et al. 2021

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Association between perihematomal perfusion and intracerebral hemorrhage shape

Cited by 5 publications

References 15 publications

Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram

Prediction of Hematoma Expansion in Hypertensive Intracerebral Hemorrhage by a Radiomics Nomogram

Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage

Assessing the Evolution of Intracranial Hematomas by using Animal Models: A Review of the Progress and the Challenges

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