Performance characteristics of methods for quantifying spontaneous intracerebral haemorrhage: data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial

Krishnan, Kailash; Mukhtar, S. F.; Lingard, James; Houlton, Aimee; Walker, Elizabeth; Jones, Tanya; Sprigg, Nikola; Cala, L.A.; Becker, Jennifer; Dineen, Robert A.; Koumellis, Panos; Adami, Alessandro; Casado, Ana M.; Bath, Philip M; Wardlaw, Joanna M.

doi:10.1136/jnnp-2014-309845

Cited by 31 publications

(29 citation statements)

References 35 publications

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“…We screened 4191 studies identified by our searches, assessed 167 for eligibility, invited 77 eligible cohorts to share data, and obtained patient-level data from 36 (47%) cohorts18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 involving 6428 patients with repeat brain imaging after intracerebral haemorrhage between 1985 and 2015 (no data up to 1984 were obtained; figure 1; appendix). 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 Countries classified as high income by the World Bank contributed to 26 (72%) of 36 collaborating cohorts versus 30 (73%) of 41 eligible cohorts that did not collaborate.…”

Section: Resultsmentioning

confidence: 99%

“…We used reports of the included cohorts to categorise their method of intracerebral haemorrhage volume measurement as a cohort-level characteristic into either the manual ABC/2 method 17 or an automated or semi-automated planimetric method 18 . We assessed risk of bias across cohorts by identifying the studies that did not meet our eligibility criteria, did not share data, or did not provide data on a sufficient number of the variables of interest (appendix).…”

Section: Methodsmentioning

confidence: 99%

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Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Salman¹,

Frantzias²,

Lee³

et al. 2018

The Lancet Neurology

256

173

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SummaryBackgroundIntracerebral haemorrhage growth is associated with poor clinical outcome and is a therapeutic target for improving outcome. We aimed to determine the absolute risk and predictors of intracerebral haemorrhage growth, develop and validate prediction models, and evaluate the added value of CT angiography.MethodsIn a systematic review of OVID MEDLINE—with additional hand-searching of relevant studies' bibliographies— from Jan 1, 1970, to Dec 31, 2015, we identified observational cohorts and randomised trials with repeat scanning protocols that included at least ten patients with acute intracerebral haemorrhage. We sought individual patient-level data from corresponding authors for patients aged 18 years or older with data available from brain imaging initially done 0·5–24 h and repeated fewer than 6 days after symptom onset, who had baseline intracerebral haemorrhage volume of less than 150 mL, and did not undergo acute treatment that might reduce intracerebral haemorrhage volume. We estimated the absolute risk and predictors of the primary outcome of intracerebral haemorrhage growth (defined as >6 mL increase in intracerebral haemorrhage volume on repeat imaging) using multivariable logistic regression models in development and validation cohorts in four subgroups of patients, using a hierarchical approach: patients not taking anticoagulant therapy at intracerebral haemorrhage onset (who constituted the largest subgroup), patients taking anticoagulant therapy at intracerebral haemorrhage onset, patients from cohorts that included at least some patients taking anticoagulant therapy at intracerebral haemorrhage onset, and patients for whom both information about anticoagulant therapy at intracerebral haemorrhage onset and spot sign on acute CT angiography were known.FindingsOf 4191 studies identified, 77 were eligible for inclusion. Overall, 36 (47%) cohorts provided data on 5435 eligible patients. 5076 of these patients were not taking anticoagulant therapy at symptom onset (median age 67 years, IQR 56–76), of whom 1009 (20%) had intracerebral haemorrhage growth. Multivariable models of patients with data on antiplatelet therapy use, data on anticoagulant therapy use, and assessment of CT angiography spot sign at symptom onset showed that time from symptom onset to baseline imaging (odds ratio 0·50, 95% CI 0·36–0·70; p<0·0001), intracerebral haemorrhage volume on baseline imaging (7·18, 4·46–11·60; p<0·0001), antiplatelet use (1·68, 1·06–2·66; p=0·026), and anticoagulant use (3·48, 1·96–6·16; p<0·0001) were independent predictors of intracerebral haemorrhage growth (C-index 0·78, 95% CI 0·75–0·82). Addition of CT angiography spot sign (odds ratio 4·46, 95% CI 2·95–6·75; p<0·0001) to the model increased the C-index by 0·05 (95% CI 0·03–0·07).InterpretationIn this large patient-level meta-analysis, models using four or five predictors had acceptable to good discrimination. These models could inform the location and frequency of observations on patients in clinical practice, explain treatment effects i...

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Salman¹,

Frantzias²,

Lee³

et al. 2018

The Lancet Neurology

256

173

View full text Add to dashboard Cite

show abstract

“…Especially, those hematomas were particularly exposed to inaccurate ABC/2 measurements, however, which implies significant volume bias within the surgical cohort. 16,[22][23][24] Regarding our hypothesis, this finding raises the possibility that inaccuracy of ABC/2 is a contributor to inconclusive results regarding surgical outcome after ICH. Moreover, it illustrates why it is of clinical interest to improve methods of ICH quantification to allow for a careful reevaluation of ICH volume as an outcome surrogate.…”

Section: Discussionmentioning

confidence: 72%

“…Moreover, segmentation algorithms have struggled with variation of slice thickness. [10][11][12]24,25 The segmentation algorithm presented here aimed to combine multiple existent segmentation methodologies in a random forest-based learning approach, which sought to mitigate the methodological limitations mentioned above and improve segmentation results compared with ABC/2.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage

Scherer

Cordes

Younsi

et al. 2016

Stroke

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Background and Purpose-ABC/2 is still widely accepted for volume estimations in spontaneous intracerebral hemorrhage (ICH) despite known limitations, which potentially accounts for controversial outcome-study results. The aim of this study was to establish and validate an automatic segmentation algorithm, allowing for quick and accurate quantification of ICH. Methods-A segmentation algorithm implementing first-and second-order statistics, texture, and threshold features was trained on manual segmentations with a random-forest methodology. Quantitative data of the algorithm, manual segmentations, and ABC/2 were evaluated for agreement in a study sample (n=28) and validated in an independent sample not used for algorithm training (n=30). Results-ABC/2 volumes were significantly larger compared with either manual or algorithm values, whereas no significant differences were found between the latter (P<0.0001; Friedman+Dunn's multiple comparison

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“…The mGS has a high inter- and intraobserver reliability [5, 6] and correlates well with IVH volume [5]. Additionally, mGS predicts poor functional outcome after ICH with higher accuracy than the original Graeb Scale (oGS) [7] from which mGS is derived [5].…”

Section: Introductionmentioning

confidence: 99%

Intraventricular Extension of Supratentorial Intracerebral Hemorrhage: The Modified Graeb Scale Improves Outcome Prediction in Lund Stroke Register

et al. 2015

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Background/Aims: The modified Graeb Scale (mGS) is a semi-quantitative method to assess the extension of intraventricular hemorrhage (IVH) in patients with intracerebral hemorrhage (ICH). The mGS has been shown to prognosticate outcome after ICH in cohorts derived from convenience samples. We evaluated the external validity of mGS in supratentorial ICH-patients from an unselected cohort. Methods: ICH-patients were included prospectively and consecutively in Lund Stroke Register. Follow-up survival status was obtained from the National Census Office; functional outcome was obtained from the Swedish Stroke Register or medical records. Using multivariate analyses, we examined if mGS was related to 30-day survival or poor functional outcome (modified Rankin Scale ≥4) at 90 days. Results: Of 198 supratentorial ICH-patients, 86 (43%) had IVH (median mGS 12, range 1-28). In multivariate regression analyses, the mGS independently predicted 30-day mortality (per point; OR 1.16; 95% CI 1.06-1.27; p = 0.002) and poor functional outcome (OR 1.11; 95% CI 1.02-1.20; p = 0.011) after ICH. In receiver-operator characteristic analysis, the addition of mGS tended to be associated with a higher prognostic accuracy for survival (area under curve 0.886 vs. not including mGS 0.812; p = 0.053). Conclusions: The mGS improves outcome prediction after supratentorial ICH beyond other previously established factors in an unselected population.

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Performance characteristics of methods for quantifying spontaneous intracerebral haemorrhage: data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial

Cited by 31 publications

References 35 publications

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage

Intraventricular Extension of Supratentorial Intracerebral Hemorrhage: The Modified Graeb Scale Improves Outcome Prediction in Lund Stroke Register

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