Predictive Validity of Hypodensities on Noncontrast Computed Tomography for Hematoma Growth in Intracerebral Hemorrhage: a Meta-Analysis

2019 ◽  
Vol 123 ◽  
pp. e639-e645 ◽  
Author(s):  
Zhiyuan Yu ◽  
Jun Zheng ◽  
Lu Ma ◽  
Rui Guo ◽  
Chao You ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Predictive Validity ◽  
Meta Analysis ◽  
Hematoma Growth ◽  
Noncontrast Computed Tomography

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

2021 ◽  
pp. 174749302110616
Author(s):  
Arba Francesco ◽  
Rinaldi Chiara ◽  
Boulouis Gregoire ◽  
Fainardi Enrico ◽  
Charidimou Andreas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Significant Risk ◽  
Irregular Shape ◽  
Hematoma Expansion ◽  
Logistic Regression Models ◽  
Noncontrast Computed Tomography

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

scholarly journals Heterogeneity Signs on Noncontrast Computed Tomography Predict Hematoma Expansion after Intracerebral Hemorrhage: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Danfeng Zhang ◽  
Jigang Chen ◽  
Qiang Xue ◽  
Bingying Du ◽  
Ya Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Random Effects Model ◽  
Poor Outcome ◽  
Increased Risk ◽  
Noncontrast Computed Tomography ◽  
Swirl Sign

Background and Purpose. Hematoma expansion (HE) is related to clinical deterioration after intracerebral hemorrhage (ICH) and noncontrast computed tomography (NCCT) signs are indicated as predictors for HE but with inconsistent conclusions. We aim to clarify the correlations of NCCT heterogeneity signs with HE by meta-analysis of related studies. Methods. PubMed, Embase, and Cochrane library were searched for eligible studies exploring the relationships between NCCT heterogeneity signs (hypodensity, mixed density, swirl sign, blend sign, and black hole sign) and HE. Poor outcome and mortality were considered as secondary outcomes. Odds ratio (OR) and its 95% confidence intervals (CIs) were selected as the effect size and combined using random effects model. Results. Fourteen studies were included, involving 3240 participants and 435 HEs. The summary results suggested statistically significant correlations of heterogeneity signs with HE (OR, 5.17; 95% CI, 3.72–7.19, P<0.001), poor outcome (OR, 3.60; 95% CI, 1.98–6.54, P<0.001), and mortality (OR, 4.64; 95%, 2.96–7.27, P<0.001). Conclusions. Our findings suggested that hematoma heterogeneity signs on NCCT were positively associated with the increased risk of HE, poor outcome, and mortality rate in ICH.

scholarly journals Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Stroke ◽  
2016 ◽  
Vol 47 (10) ◽  
pp. 2511-2516 ◽  
Author(s):  
Gregoire Boulouis ◽  
Andrea Morotti ◽  
H. Bart Brouwers ◽  
Andreas Charidimou ◽  
Michael J. Jessel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Poor Outcome ◽  
Noncontrast Computed Tomography

scholarly journals External Validation of the Secondary Intracerebral Hemorrhage Score in The Netherlands

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2904-2906 ◽  
Author(s):  
Charlotte J.J. van Asch ◽  
Birgitta K. Velthuis ◽  
Jacoba P. Greving ◽  
Peter Jan van Laar ◽  
Gabriël J.E. Rinkel ◽  
...  
Keyword(s):  
United States ◽  
Computed Tomography ◽  
The Netherlands ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
The United States ◽  
Pathological Examination ◽  
Discriminative Ability ◽  
Ich Score ◽  
Noncontrast Computed Tomography

Background and Purpose— We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH. Methods— Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause). Results— Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration ( P =0.06) and modest discriminative ability ( c -statistic 0.73; 95% confidence interval, 0.65–0.80). Discrimination improved slightly using only noncontrast computed tomography categorization ( c -statistic 0.79; 95% confidence interval, 0.72–0.86). Conclusions— The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.

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