External validation of the diagnostic value of perihematomal edema characteristics in neoplastic and non-neoplastic intracerebral hemorrhage.
brain tumor
computed tomography
intracerebral hemorrhage
metastases
perihematomal edema
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
21
02
2023
received:
18
01
2023
accepted:
22
02
2023
medline:
8
5
2023
pubmed:
28
2
2023
entrez:
27
2
2023
Statut:
ppublish
Résumé
Neoplastic intracerebral hemorrhage (ICH) may be incorrectly identified as non-neoplastic ICH on imaging. Relative perihematomal edema (relPHE) on computed tomography (CT) has been proposed as a marker to discriminate neoplastic from non-neoplastic ICH but has not been externally validated. The purpose of this study was to evaluate the discriminatory power of relPHE in an independent cohort. A total of 291 patients with acute ICH on CT and follow-up magnetic resonance imaging (MRI) were included in this single-center retrospective study. ICH subjects were dichotomized into non-neoplastic or neoplastic ICH based on the diagnosis on the follow-up MRI. ICH and PHE volumes and density values were derived from semi-manually segmented CT scans. Calculated PHE characteristics for discriminating neoplastic ICH were evaluated using receiver-operating characteristic (ROC) curves. ROC curve-associated cut-offs were calculated and compared between the initial and the validation cohort. A total of 116 patients (39.86%) with neoplastic ICH and 175 (60.14%) with non-neoplastic ICH were included. Median PHE volumes, relPHE, and relPHE adjusted for hematoma density were significantly higher in subjects with neoplastic ICH (all p values <0.001). ROC curves for relPHE had an area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.66-0.78) and an AUC of 0.81 (95% CI 0.76-0.87) for adjusted relPHE. The cut-offs were identical in the two cohorts, with >0.70 for relPHE and >0.01 for adjusted relPHE. Relative perihematomal edema and adjusted relPHE accurately discriminated neoplastic from non-neoplastic ICH on CT imaging in an external patient cohort. These results confirmed the findings of the initial study and may improve clinical decision making.
Sections du résumé
BACKGROUND AND PURPOSE
Neoplastic intracerebral hemorrhage (ICH) may be incorrectly identified as non-neoplastic ICH on imaging. Relative perihematomal edema (relPHE) on computed tomography (CT) has been proposed as a marker to discriminate neoplastic from non-neoplastic ICH but has not been externally validated. The purpose of this study was to evaluate the discriminatory power of relPHE in an independent cohort.
METHODS
A total of 291 patients with acute ICH on CT and follow-up magnetic resonance imaging (MRI) were included in this single-center retrospective study. ICH subjects were dichotomized into non-neoplastic or neoplastic ICH based on the diagnosis on the follow-up MRI. ICH and PHE volumes and density values were derived from semi-manually segmented CT scans. Calculated PHE characteristics for discriminating neoplastic ICH were evaluated using receiver-operating characteristic (ROC) curves. ROC curve-associated cut-offs were calculated and compared between the initial and the validation cohort.
RESULTS
A total of 116 patients (39.86%) with neoplastic ICH and 175 (60.14%) with non-neoplastic ICH were included. Median PHE volumes, relPHE, and relPHE adjusted for hematoma density were significantly higher in subjects with neoplastic ICH (all p values <0.001). ROC curves for relPHE had an area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.66-0.78) and an AUC of 0.81 (95% CI 0.76-0.87) for adjusted relPHE. The cut-offs were identical in the two cohorts, with >0.70 for relPHE and >0.01 for adjusted relPHE.
CONCLUSIONS
Relative perihematomal edema and adjusted relPHE accurately discriminated neoplastic from non-neoplastic ICH on CT imaging in an external patient cohort. These results confirmed the findings of the initial study and may improve clinical decision making.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1686-1695Informations de copyright
© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9:167-176.
Burth S, Ohmann M, Kronsteiner D, et al. Prophylactic anticoagulation in patients with glioblastoma or brain metastases and atrial fibrillation: an increased risk for intracranial hemorrhage? J Neurooncol. 2021;152:483-490.
Hamed M, Schäfer N, Bode C, et al. Preoperative metastatic brain tumor-associated intracerebral hemorrhage is associated with dismal prognosis. Front Oncol. 2021;11:1.
Ostrowski RP, He Z, Pucko EB, Matyja E. Hemorrhage in brain tumor - an unresolved issue. Brain Hemorrhages. 2022;3:98-102.
Tseng JH, Lin WH. Glioblastoma multiforme hiding behind the intracerebral hematoma. Formos J Surg. 2012;45:183-186.
Li L, Yin J, Li Y, et al. Anaplastic astrocytoma masquerading as hemorrhagic stroke. J Clin Neurosci. 2013;20:1612-1614.
Kambe A, Hosoya T, Sakamoto M, Kondo S, Kurosaki M. High-grade glioma masquerading as a small cerebral hemorrhage: a case report. Yonago Acta Med. 2019;62:305-307.
Choi G, Park DH, Kang SH, Chung YG. Glioma mimicking a hypertensive intracerebral hemorrhage. J Korean Neurosurg Soc. 2013;54:125-127.
Singla N, Aggarwal A, Vyas S, Sanghvi A, Salunke P, Garg R. Glioblastoma multiforme with hemorrhage mimicking an aneurysm: lessons learnt. Ann Neurosci. 2016;23:263-265.
Shankar JJS, Sinha N. Diagnosing neoplastic hematoma: role of MR perfusion. Clin Neuroradiol. 2019;29:263-268.
Kondziolka D, Bernstein M, Resch L, et al. Significance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg. 1987;67:852-857.
Deng XH, Li J, Chen SJ, et al. Clinical features of intracerebral hemorrhage in patients with colorectal cancer and its underlying pathogenesis. World J Gastrointest Oncol. 2021;13:2180-2189.
Nawabi J, Hanning U, Broocks G, et al. Neoplastic and non-neoplastic causes of acute intracerebral hemorrhage on CT: the diagnostic value of perihematomal edema. Clin Neuroradiol. 2019;30:2180-2189.
Nawabi J, Kniep H, Kabiri R, et al. Neoplastic and non-neoplastic acute intracerebral hemorrhage in CT brain scans: machine learning-based prediction using radiomic image features. Front Neurol. 2020;11:285.
Martí-Fàbregas J, Prats-Sánchez L, Martínez-Domeño A, et al. The H-ATOMIC criteria for the etiologic classification of patients with intracerebral hemorrhage. PLoS One. 2016;11:e0156992.
Goeldlin MB, Mueller A, Siepen BM, et al. Etiology, 3-month functional outcome and recurrent events in non-traumatic intracerebral hemorrhage. J Stroke. 2022;24:266-277. /.
Smith EE, Rosand J, Greenberg SM. Hemorrhagic stroke. Neuroimaging Clin N Am. 2005;15:259-272.
Volbers B, Staykov D, Wagner I, et al. Semi-automatic volumetric assessment of perihemorrhagic edema with computed tomography. Eur J Neurol. 2011;18:1323-1328.
Vollmuth P, Foltyn M, Huang RY, et al. AI-based decision support improves reproducibility of tumor response assessment in neuro-oncology: an international multi-reader study. Neuro Oncol. 2023;25(3):533-543. doi:10.1093/neuonc/noac189
Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol. 2004;5:11-18.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837.
Freedman D, Pisani R, Purves R. Statistics: Fourth International Student Edition. 2007 Accessed January 9, 2023. https://www.wiley.com/en-au/Statistics%2C+4th+Edition+International+Student+Edition-p-9780393930436
Management of vasogenic edema in patients with primary and metastatic brain tumors - UpToDate. Accessed November 30, 2022. https://www.uptodate.com/contents/management-of-vasogenic-edema-in-patients-with-primary-and-metastatic-brain-tumors/print
Choi YS, Rim TH, Ahn SS, Lee S-K. Discrimination of tumorous intracerebral hemorrhage from benign causes using CT densitometry. Am J Neuroradiol. 2015;36:886-892.
Ironside N, Chen CJ, Mutasa S, et al. Fully automated segmentation algorithm for perihematomal edema volumetry after spontaneous intracerebral hemorrhage. Stroke. 2020;51(3):815-823.
Zhao X, Chen K, Wu G, et al. Deep learning shows good reliability for automatic segmentation and volume measurement of brain hemorrhage, intraventricular extension, and peripheral edema. Eur Radiol. 2021;31:5012-5020.