Early prediction of clinical outcomes in patients with aneurysmal subarachnoid hemorrhage using computed tomography texture analysis. (January 2020)

• Record Type: Journal Article
• Authors: Kanazawa, Tokunori; Takahashi, Satoshi; Minami, Yasuhiro; Jinzaki, Masahiro; Toda, Masahiro; Yoshida, Kazunari
• Is Part Of: Journal of clinical neuroscience. Volume 71(2020)
• Page Start: 144
• Page End: 149
• Publication Date: 2020-01
• Subjects: AUC area under the curve -- CI confidence interval -- CT computed tomography -- CTA computed tomography angiography -- CTP computed tomography perfusion -- CTTA computed tomography texture analysis -- DCI delayed cerebral ischemia -- EBI early brain injury -- GCE global cerebral edema -- GCS Glasgow Coma Scale -- HH Hunt and Hess -- HU Hounsfield unit -- ICC intraclass correlation -- MRA magnetic resonance angiography -- mRS modified Rankin scale -- NPV negative predictive value -- PPV positive predictive value -- ROC receiver operating characteristic -- ROI region of interest -- SAH subarachnoid hemorrhage -- SEBES Subarachnoid Hemorrhage Early Brain Edema Score -- SD standard deviation -- WFNS World Federation of Neurological Surgeons; Subarachnoid hemorrhage -- Texture analysis -- Mean CT value -- Prognosis -- Cerebral edema -- Cerebral vasospasm -- Delayed cerebral ischemia; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.08.098
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: The mean CT value of blood clots in the subarachnoid space could predict clinical outcomes in SAH. No texture parameters for cerebral edema were significantly associated with clinical outcomes. The hemorrhage density may predict clinical prognosis and help to prevent vasospasm and DCI. Abstract: Radiological evaluation of subarachnoid hemorrhage (SAH) is often subject to interobserver variability. The aim of this study was to retrospectively detect computed tomography (CT) texture parameters in the early postictal state to predict cerebral vasospasm, delayed cerebral ischemia (DCI), and functional outcome in aneurysmal SAH using quantitative CT texture analysis (CTTA) via a commercially available software program and routine CT images. 40 patients with aneurysmal SAH surgically treated at the Keio University Hospital during a four-year period were analyzed. CT texture analyses were performed using a commercially available software program (Synapse Vincent). The following texture parameters of blood clots in the subarachnoid space and cerebral edema were assessed: mean CT value, entropy, skewness, and kurtosis. The mean CT value of blood clots in the subarachnoid space was significantly associated with cerebral vasospasm, DCI, and functional outcome. The mean CT value ≥ 49.64 Hounsfield units (HU) predicted cerebral vasospasm with a sensitivity and specificity of 85.7% and 61.5%, respectively (area under the curve [AUC] = 0.758). The mean CT value ≥ 49.95 HU predicted DCI with a sensitivity and specificity of 100% and 60.6%, respectively (AUC = 0.810). The mean CT value ≥ 53.00 HU predicted poor functional outcome with a sensitivity and specificity of 56.3% and 91.7%, respectively (AUC = 0.747). CTTA using a commercially available software program demonstrated that the mean CT value of clots in the subarachnoid space in the early postictal state could predict vasospasm, DCI, and clinical outcome with a high sensitivity and specificity.