TY - JOUR
T1 - Abilities of a densitometric analysis of computed tomography images and hemorrhagic parameters to predict outcome favorability in patients with intracerebral hemorrhage
AU - Kim, Hakseung
AU - Yang, Xiaoke
AU - Choi, Young Hun
AU - Yoon, Byung C.
AU - Kim, Keewon
AU - Kim, Dong-Joo
N1 - Funding Information:
This research was supported by the MSIP (Ministry of Science, ICT and Future Planning), Korea, under the ITRC (Information Technology Research Center) support program (IITP-2017-2016-0-00464) supervised by the IITP (Institute for Information & communications Technology Promotion). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
Copyright © 2017 by the Congress of Neurological Surgeons
PY - 2018/8
Y1 - 2018/8
N2 - BACKGROUND: Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE: To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS: Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS: The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION: Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
AB - BACKGROUND: Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE: To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS: Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS: The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION: Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
KW - Computed tomography
KW - Critical care
KW - Intracerebral hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=85058775688&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyx379
DO - 10.1093/neuros/nyx379
M3 - Article
C2 - 28973583
AN - SCOPUS:85058775688
VL - 83
SP - 226
EP - 236
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 2
ER -