Development and Validation of an Automatic Segmentation Algorithm for Quantification of Intracerebral Hemorrhage. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Scherer, Moritz; Cordes, Jonas; Younsi, Alexander; Sahin, Yasemin-Aylin; Götz, Michael; Möhlenbruch, Markus; Stock, Christian; Bösel, Julian; Unterberg, Andreas; Maier-Hein, Klaus; Orakcioglu, Berk
• Is Part Of: Stroke. Volume 47:Issue 11(2016)
• Publication Date: 2016-11
• Subjects: computed tomography -- computer-assisted image analysis -- intracerebral hemorrhage -- machine learning -- volumetric analysis; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.116.013779
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: ABC/2 is still widely accepted for volume estimations in spontaneous intracerebral hemorrhage (ICH) despite known limitations, which potentially accounts for controversial outcome-study results. The aim of this study was to establish and validate an automatic segmentation algorithm, allowing for quick and accurate quantification of ICH. Methods—: A segmentation algorithm implementing first- and second-order statistics, texture, and threshold features was trained on manual segmentations with a random-forest methodology. Quantitative data of the algorithm, manual segmentations, and ABC/2 were evaluated for agreement in a study sample (n=28) and validated in an independent sample not used for algorithm training (n=30). Results—: ABC/2 volumes were significantly larger compared with either manual or algorithm values, whereas no significant differences were found between the latter ( P <0.0001; Friedman+Dunn's multiple comparison). Algorithm agreement with the manual reference was strong (concordance correlation coefficient 0.95 [lower 95% confidence interval 0.91]) and superior to ABC/2 (concordance correlation coefficient 0.77 [95% confidence interval 0.64]). Validation confirmed agreement in an independent sample (algorithm concordance correlation coefficient 0.99 [95% confidence interval 0.98], ABC/2 concordance correlation coefficient 0.82 [95% confidence interval 0.72]). The algorithm was closer to respective manual segmentations than ABC/2 in 52/58 cases (89.7%). Conclusions—: An automatic segmentation algorithm for volumetric analysis of spontaneous ICH was developed and validated in this study. Algorithm measurements showed strong agreement with manual segmentations, whereas ABC/2 exhibited its limitations, yielding inaccurate overestimations of ICH volume. The refined, yet time-efficient, quantification of ICH by the algorithm may facilitate evaluation of clot volume as an outcome predictor and trigger for surgical interventions in the clinical setting. Abstract : Supplemental Digital Content is available in the text.