nach oben

Neuroradiology

Erschienen in:

27.01.2022 | Diagnostic Neuroradiology

A predictive nomogram for intracerebral hematoma expansion based on non-contrast computed tomography and clinical features

verfasst von: Xiuping Zhang, Qianqian Gao, Kaidong Chen, Qiuxiang Wu, Bixue Chen, Shangyu Zeng, Xiangming Fang

Erschienen in: Neuroradiology | Ausgabe 8/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To develop and validate a new nomogram utilizing non-contrast computed tomography (NCCT) signs and clinical factors for predicting hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (ICH).

Methods

HE was defined as > 6 mL or 33% increase in baseline hematoma volume. Multivariable logistic regression analysis was performed to identify the predictors of HE. The discriminatory performance of the proposed model was evaluated via receiver operation characteristic (ROC) analysis, and the predictive accuracy was assessed by a calibration curve. The nomogram was established by R programming language. The decision curve analysis and clinical impact curve were drawn according to the related risk factors.

Results

A total of 506 patients with spontaneous ICH were recruited in the development cohort, and 103 patients were registered as the external validation cohort. Among the development cohort, 132 (26.09%) experienced HE. Glasgow coma scale (GCS) (P < 0.001), neutrophil to lymphocyte ratio (NLR) (P < 0.001), blend sign (P < 0.001), swirl sign (P < 0.001), and hypodensities (P = 0.003) were significant predictors of HE, by which were used to establish the nomogram. The model demonstrated good performance with high area under the curve both in the development (AUC = 0.908; 95% confidence interval, 0.880–0.936) and the external validation (AUC = 0.844; 95% confidence interval, 0.760–0.908) cohort. The calibration curve illustrated a high accuracy for HE prediction.

Conclusion

The nomogram derived from NCCT markers and clinical factors outperformed the NCCT signs-only model in predicting HE for patients with ICH, thus providing an effective and noninvasive tool for the risk stratification of HE.

Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TW, Vashkevich A, McNamara KA, Valant V, Schwab K, Orzell SC, Bresette LM, Feske SK, Rost NS, Romero JM, Viswanathan A, Chou SH, Greenberg SM, Rosand J, Goldstein JN (2014) Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol 71(2):158–164. https://doi.org/10.1001/jamaneurol.2013.5433CrossRefPubMedPubMedCentral

Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE (2011) Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology 76(14):1238–1244. https://doi.org/10.1212/WNL.0b013e3182143317CrossRefPubMedPubMedCentral

Al-Shahi Salman R, Law ZK, Bath PM, Steiner T, Sprigg N (2018) Haemostatic therapies for acute spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 4(4):Cd005951. https://doi.org/10.1002/14651858.CD005951.pub4CrossRefPubMed

Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J (2013) Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368(25):2355–2365. https://doi.org/10.1056/NEJMoa1214609CrossRefPubMed

Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW (2016) Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 375(11):1033–1043. https://doi.org/10.1056/NEJMoa1603460CrossRefPubMedPubMedCentral

Xu X, Zhang J, Yang K, Wang Q, Xu B, Chen X (2018) Accuracy of spot sign in predicting hematoma expansion and clinical outcome: a meta-analysis. Medicine 97(34):e11945. https://doi.org/10.1097/md.0000000000011945CrossRefPubMedPubMedCentral

Peng WJ, Reis C, Reis H, Zhang J, Yang J (2017) Predictive value of CTA spot sign on hematoma expansion in intracerebral hemorrhage patients. Biomed Res Int 2017:4137210. https://doi.org/10.1155/2017/4137210CrossRefPubMedPubMedCentral

Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, Pontes-Neto O, Ayres A, Vashkevich A, Schwab KM, Rosand J, Viswanathan A, Gurol ME, Greenberg SM, Goldstein JN (2016) Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage. JAMA Neurol 73(8):961–968. https://doi.org/10.1001/jamaneurol.2016.1218CrossRefPubMedPubMedCentral

Yu Z, Zheng J, Ma L, Guo R, You C, Li H (2019) Predictive validity of hypodensities on noncontrast computed tomography for hematoma growth in intracerebral hemorrhage: a meta-analysis. World Neurosurg 123:e639–e645. https://doi.org/10.1016/j.wneu.2018.11.239CrossRefPubMed

10.

Morotti A, Boulouis G, Romero JM, Brouwers HB, Jessel MJ, Vashkevich A, Schwab K, Afzal MR, Cassarly C, Greenberg SM, Martin RH, Qureshi AI, Rosand J, Goldstein JN (2017) Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion. Neurology 89(6):548–554. https://doi.org/10.1212/wnl.0000000000004210CrossRefPubMedPubMedCentral

11.

Li Q, Zhang G, Huang YJ, Dong MX, Lv FJ, Wei X, Chen JJ, Zhang LJ, Qin XY, Xie P (2015) Blend sign on computed tomography: novel and reliable predictor for early hematoma growth in patients with intracerebral hemorrhage. Stroke 46(8):2119–2123. https://doi.org/10.1161/strokeaha.115.009185CrossRefPubMed

12.

Li Q, Zhang G, Xiong X, Wang XC, Yang WS, Li KW, Wei X, Xie P (2016) Black hole sign: novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage. Stroke 47(7):1777–1781. https://doi.org/10.1161/strokeaha.116.013186CrossRefPubMed

13.

Li Q, Liu QJ, Yang WS, Wang XC, Zhao LB, Xiong X, Li R, Cao D, Zhu D, Wei X, Xie P (2017) Island sign: an imaging predictor for early hematoma expansion and poor outcome in patients with intracerebral hemorrhage. Stroke 48(11):3019–3025. https://doi.org/10.1161/strokeaha.117.017985CrossRefPubMed

14.

Shimoda Y, Ohtomo S, Arai H, Okada K, Tominaga T (2017) Satellite sign: a poor outcome predictor in intracerebral hemorrhage. Cerebrovasc Dis 44(3–4):105–112. https://doi.org/10.1159/000477179CrossRefPubMed

15.

Barras CD, Tress BM, Christensen S, MacGregor L, Collins M, Desmond PM, Skolnick BE, Mayer SA, Broderick JP, Diringer MN, Steiner T, Davis SM (2009) Density and shape as CT predictors of intracerebral hemorrhage growth. Stroke 40(4):1325–1331. https://doi.org/10.1161/strokeaha.108.536888CrossRefPubMed

16.

Du C, Liu B, Yang M, Zhang Q, Ma Q, Ruili R (2020) Prediction of poor outcome in intracerebral hemorrhage based on computed tomography markers. Cerebrovasc Dis 49(5):556–562. https://doi.org/10.1159/000510805CrossRefPubMed

17.

Selariu E, Zia E, Brizzi M, Abul-Kasim K (2012) Swirl sign in intracerebral haemorrhage: definition, prevalence, reliability and prognostic value. BMC Neurol 12:109. https://doi.org/10.1186/1471-2377-12-109CrossRefPubMedPubMedCentral

18.

Boulouis G, Morotti A, Charidimou A, Dowlatshahi D, Goldstein JN (2017) Noncontrast computed tomography markers of intracerebral hemorrhage expansion. Stroke 48(4):1120–1125. https://doi.org/10.1161/strokeaha.116.015062CrossRefPubMedPubMedCentral

19.

Bakar B, Akkaya S, Say B, Yuksel U, Alhan A, Turğut E, Ogden M, Ergun U (2021) In spontaneous intracerebral hematoma patients, prediction of the hematoma expansion risk and mortality risk using radiological and clinical markers and a newly developed scale. Neurol Res 43(6):482–495. https://doi.org/10.1080/01616412.2020.1870338CrossRefPubMed

20.

Yao X, Xu Y, Siwila-Sackman E, Wu B, Selim M (2015) The HEP score: a nomogram-derived hematoma expansion prediction scale. Neurocrit Care 23(2):179–187. https://doi.org/10.1007/s12028-015-0147-4CrossRefPubMed

21.

Miyahara M, Noda R, Yamaguchi S, Tamai Y, Inoue M, Okamoto K, Hara T (2018) New prediction score for hematoma expansion and neurological deterioration after spontaneous intracerebral hemorrhage: a hospital-based retrospective cohort study. J Stroke Cerebrovasc Dis 27(9):2543–2550. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.05.018CrossRefPubMed

22.

Li Q, Shen YQ, Xie XF, Xue MZ, Cao D, Yang WS, Li R, Deng L, Wei M, Lv FJ, Wu GF, Tang ZP, Xie P (2019) Expansion-prone hematoma: defining a population at high risk of hematoma growth and poor outcome. Neurocrit Care 30(3):601–608. https://doi.org/10.1007/s12028-018-0644-3CrossRefPubMed

23.

Morotti A, Charidimou A, Phuah CL, Jessel MJ, Schwab K, Ayres AM, Romero JM, Viswanathan A, Gurol ME, Greenberg SM, Anderson CD, Rosand J, Goldstein JN (2016) Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage. JAMA Neurol 73(11):1285–1290. https://doi.org/10.1001/jamaneurol.2016.2252CrossRefPubMedPubMedCentral

24.

Chu H, Huang C, Dong J, Yang X, Xiang J, Dong Q, Tang Y (2019) Lactate dehydrogenase predicts early hematoma expansion and poor outcomes in intracerebral hemorrhage patients. Transl Stroke Res 10(6):620–629. https://doi.org/10.1007/s12975-019-0686-7CrossRefPubMed

25.

Kattan MW (2003) Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Curr Opin Urol 13(2):111–116. https://doi.org/10.1097/00042307-200303000-00005CrossRefPubMed

26.

Zhang Y, Zhang W, Liu L (2019) Comments on 2018 ESC/ESH hypertension guidelines: Chinese perspective. Circ Res 124(7):978–980. https://doi.org/10.1161/circresaha.119.314997CrossRefPubMed

27.

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC (2020) 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 41(2):255–323. https://doi.org/10.1093/eurheartj/ehz486CrossRefPubMed

28.

Morotti A, Boulouis G, Dowlatshahi D, Li Q, Barras CD, Delcourt C, Yu Z, Zheng J, Zhou Z, Aviv RI, Shoamanesh A, Sporns PB, Rosand J, Greenberg SM, Al-Shahi Salman R, Qureshi AI, Demchuk AM, Anderson CS, Goldstein JN, Charidimou A (2019) Standards for detecting, interpreting, and reporting noncontrast computed tomographic markers of intracerebral hemorrhage expansion. Ann Neurol 86(4):480–492. https://doi.org/10.1002/ana.25563CrossRefPubMed

29.

Steiner T, Bösel J (2010) Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage. Stroke 41(2):402–409. https://doi.org/10.1161/strokeaha.109.552919CrossRefPubMed

30.

Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Blas YS, Dzialowski I, Kobayashi A, Boulanger JM, Lum C, Gubitz G, Padma V, Roy J, Kase CS, Kosior J, Bhatia R, Tymchuk S, Subramaniam S, Gladstone DJ, Hill MD, Aviv RI (2012) Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol 11(4):307–314. https://doi.org/10.1016/s1474-4422(12)70038-8CrossRefPubMed

31.

Huang Y, Zhang Q, Yang M (2018) A reliable grading system for prediction of hematoma expansion in intracerebral hemorrhage in the basal ganglia. Biosci Trends 12(2):193–200. https://doi.org/10.5582/bst.2018.01061CrossRefPubMed

32.

Zhang D, Chen J, Xue Q, Du B, Li Y, Chen T, Jiang Y, Hou L, Dong Y, Wang J (2018) Heterogeneity signs on noncontrast computed tomography predict hematoma expansion after intracerebral hemorrhage: a meta-analysis. Biomed Res Int 2018:6038193. https://doi.org/10.1155/2018/6038193CrossRefPubMedPubMedCentral

33.

Ng D, Churilov L, Mitchell P, Dowling R, Yan B (2018) The CT swirl sign is associated with hematoma expansion in intracerebral hemorrhage. AJNR Am J Neuroradiol 39(2):232–237. https://doi.org/10.3174/ajnr.A5465CrossRefPubMedPubMedCentral

34.

Yu Z, Zheng J, He M, Guo R, Ma L, You C, Li H (2019) Accuracy of swirl sign for predicting hematoma enlargement in intracerebral hemorrhage: a meta-analysis. J Neurol Sci 399:155–160. https://doi.org/10.1016/j.jns.2019.02.032CrossRefPubMed

35.

Amoo M, Henry J, Alabi PO, Husien MB (2021) The ‘swirl sign’ as a marker for haematoma expansion and outcome in intra-cranial haemorrhage: a meta-analysis. J Clin Neurosci 87:103–111. https://doi.org/10.1016/j.jocn.2021.02.028CrossRefPubMed

36.

Yang M, Du C, Zhang Q, Ma Q, Li R (2020) Nomogram model for predicting hematoma expansion in spontaneous intracerebral hemorrhage: multicenter retrospective study. World Neurosurg 137:e470–e478. https://doi.org/10.1016/j.wneu.2020.02.004CrossRefPubMed

37.

Menon G, Johnson SE, Hegde A, Rathod S, Nayak R, Nair R (2021) Neutrophil to lymphocyte ratio - a novel prognostic marker following spontaneous intracerebral haemorrhage. Clin Neurol Neurosurg 200:106339. https://doi.org/10.1016/j.clineuro.2020.106339CrossRefPubMed

38.

Gong X, Lu Z, Feng X, Yu C, Xue M, Yu L, Wang T, Cheng X, Lu J, Zhang M (2020) Elevated neutrophil-to-lymphocyte ratio predicts depression after intracerebral hemorrhage. Neuropsychiatr Dis Treat 16:2153–2159. https://doi.org/10.2147/ndt.S269210CrossRefPubMedPubMedCentral

Titel: A predictive nomogram for intracerebral hematoma expansion based on non-contrast computed tomography and clinical features
verfasst von: Xiuping Zhang
Qianqian Gao
Kaidong Chen
Qiuxiang Wu
Bixue Chen
Shangyu Zeng
Xiangming Fang
Publikationsdatum: 27.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 8/2022
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-022-02899-9

Thalamocortical functional connectivity in infants with prenatal opioid exposure correlates with severity of neonatal opioid withdrawal syndrome

Paediatric Neuroradiology

Use of deep learning in the MRI diagnosis of Chiari malformation type I

Open Access
Diagnostic Neuroradiology

Cerebral blood vessels and perfusion in the pediatric brain death: five cases studied by neuroimaging

Paediatric Neuroradiology

MRI detection of suspected nasopharyngeal carcinoma: a systematic review and meta-analysis

Open Access
Review

A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry

Interventional Neuroradiology

European Society of Neuroradiology (ESNR)

Society News

Kompaktes Leitlinien-Wissen Neurologie (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Kostenlos registrieren

Neu im Fachgebiet Neurologie

„Wir wollen die Bedeutung von Gen- und Umwelteinflüssen besser verstehen“

Bipolare Störung
Interview

Eine Mutation in einem einzelnen Gen kann bei Mäusen eine Art Bipolarstörung auslösen. PD Dr. Jan Deussing vom Max-Planck-Institut für Psychiatrie in München sieht in solchen Tiermodellen eine Möglichkeit, den Ursachen der Erkrankung auf den Grund zu gehen.

Suizidassistenz erhöht Suizidzahlen: Aktuelle Ergebnisse der geplanten S3-Leitlinie

DGPPN 2024
Kongressbericht

Erstmals wird in Deutschland eine S3-Leitlinie zum Thema Suizidalität erarbeitet. Ziel ist es, die Versorgung in suizidalen Krisen durch einheitliche Standards zu verbessern. Erste Ergebnisse der bisherigen Leitlinienarbeit wurden auf dem DGPPN-Kongress vorgestellt.

Kaum Vorteile durch intraarterielle Lyse während Thrombektomie

17.01.2025
Ischämischer Schlaganfall
Nachrichten

Nach der Thrombektomie kleinere Fragmente über eine intraarterielle Lyse auflösen – dies könnte die Schlaganfalltherapie verbessern. Zwei aktuelle Studien ergeben für die periprozedurale Lyse jedoch keine großen Vorteile. Die Frage, wie viel sie nützt, bleibt weiter offen.

Nasenstimulation lindert chronische Migräne

16.01.2025
Chronische Migräne
Nachrichten

Wird die Naseninnenseite durch Vibrationen stimuliert, kann dies offenbar die Zahl der Migränetage von Menschen mit chronischer Migräne deutlich senken. Darauf deuten die Resultate einer randomisiert-kontrollierten deutsch-finnischen Untersuchung.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

A predictive nomogram for intracerebral hematoma expansion based on non-contrast computed tomography and clinical features