TY - JOUR
T1 - Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities
AU - Rodriguez-Luna, David
AU - Pancorbo, Olalla
AU - Coscojuela, Pilar
AU - Lozano, Prudencio
AU - Rizzo, Federica
AU - Olivé-Gadea, Marta
AU - Requena, Manuel
AU - García-Tornel, Álvaro
AU - Rodríguez-Villatoro, Noelia
AU - Juega, Jesús M.
AU - Boned, Sandra
AU - Muchada, Marián
AU - Pagola, Jorge
AU - Rubiera, Marta
AU - Ribo, Marc
AU - Tomasello, Alejandro
AU - Molina, Carlos A.
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to European Society of Radiology.
PY - 2023/9
Y1 - 2023/9
N2 - Objectives: To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. Methods: After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. Results: The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58–0.80) and 0.59 (0.46–0.72) for NCCT score, significantly lower than 0.75 ([0.64–0.87], p = 0.038) and 0.72 ([0.59–0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68–0.89], p = 0.033) and 0.73 ([0.62–0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively. Conclusion: This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. Key Points: • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.
AB - Objectives: To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. Methods: After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. Results: The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58–0.80) and 0.59 (0.46–0.72) for NCCT score, significantly lower than 0.75 ([0.64–0.87], p = 0.038) and 0.72 ([0.59–0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68–0.89], p = 0.033) and 0.73 ([0.62–0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively. Conclusion: This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. Key Points: • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.
KW - Cerebral hemorrhage
KW - Computed tomography angiography
KW - Humans
KW - Prognosis
KW - Tomography, X-ray computed
UR - http://www.scopus.com/inward/record.url?scp=85152669284&partnerID=8YFLogxK
UR - https://www.webofscience.com/wos/woscc/full-record/WOS:000968681400001
U2 - 10.1007/s00330-023-09621-0
DO - 10.1007/s00330-023-09621-0
M3 - Article
C2 - 37059906
AN - SCOPUS:85152669284
SN - 0938-7994
VL - 33
SP - 6045
EP - 6053
JO - European radiology
JF - European radiology
IS - 9
ER -