PMID- 37734180
OWN - NLM
STAT- Publisher
LR  - 20231022
IS  - 1532-8511 (Electronic)
IS  - 1052-3057 (Linking)
VI  - 32
IP  - 11
DP  - 2023 Nov
TI  - Clinical potential of automated convolutional neural network-based hematoma 
      volumetry after aneurysmal subarachnoid hemorrhage.
PG  - 107357
LID - S1052-3057(23)00380-4 [pii]
LID - 10.1016/j.jstrokecerebrovasdis.2023.107357 [doi]
AB  - OBJECTIVES: Cerebrospinal fluid hemoglobin has been positioned as a potential 
      biomarker and drug target for aneurysmal subarachnoid hemorrhage-related 
      secondary brain injury (SAH-SBI). The maximum amount of hemoglobin, which may be 
      released into the cerebrospinal fluid, is defined by the initial subarachnoid 
      hematoma volume (ISHV). In patients without external ventricular or lumbar drain, 
      there remains an unmet clinical need to predict the risk for SAH-SBI. The aim of 
      this study was to explore automated segmentation of ISHV as a potential surrogate 
      for cerebrospinal fluid hemoglobin to predict SAH-SBI. METHODS: This study is 
      based on a retrospective analysis of imaging and clinical data from 220 
      consecutive patients with aneurysmal subarachnoid hemorrhage collected over a 
      five-year period. 127 annotated initial non-contrast CT scans were used to train 
      and test a convolutional neural network to automatically segment the ISHV in the 
      remaining cohort. Performance was reported in terms of Dice score and intraclass 
      correlation. We characterized the associations between ISHV and baseline cohort 
      characteristics, SAH-SBI, ventriculoperitoneal shunt dependence, functional 
      outcome, and survival. Established clinical (World Federation of Neurosurgical 
      Societies, Hunt & Hess) and radiological (modified Fisher, Barrow Neurological 
      Institute) scores served as references. RESULTS: A strong volume agreement (0.73 
      Dice, range 0.43 - 0.93) and intraclass correlation (0.89, 95% CI, 0.81-0.94) 
      were shown. While ISHV was not associated with the use of antithrombotics or 
      cardiovascular risk factors, there was strong evidence for an association with a 
      lower Glasgow Coma Scale at hospital admission. Aneurysm size and location were 
      not associated with ISHV, but the presence of intracerebral or intraventricular 
      hemorrhage were independently associated with higher ISHV. Despite strong 
      evidence for a positive association between ISHV and SAH-SBI, the discriminatory 
      ability of ISHV for SAH-SBI was insufficient. The discriminatory ability of ISHV 
      was, however, higher regarding ventriculoperitoneal shunt dependence and 
      functional outcome at three-months follow-up. Multivariate survival analysis 
      provided strong evidence for an independent negative association between survival 
      probability and both ISHV and intraventricular hemorrhage. CONCLUSIONS: The 
      proposed algorithm demonstrates strong performance in volumetric segmentation of 
      the ISHV on the admission CT. While the discriminatory ability of ISHV for 
      SAH-SBI was similar to established clinical and radiological scores, it showed a 
      high discriminatory ability for ventriculoperitoneal shunt dependence and 
      functional outcome at three-months follow-up.
CI  - Copyright (c) 2023 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Thomson, Bart R
AU  - Thomson BR
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland; Division of 
      Internal Medicine, Universitatsspital and University of Zurich, Zurich, 
      Switzerland.
FAU - Gurlek, Firat
AU  - Gurlek F
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland; Division of 
      Internal Medicine, Universitatsspital and University of Zurich, Zurich, 
      Switzerland.
FAU - Buzzi, Raphael M
AU  - Buzzi RM
AD  - Division of Internal Medicine, Universitatsspital and University of Zurich, 
      Zurich, Switzerland.
FAU - Schwendinger, Nina
AU  - Schwendinger N
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
FAU - Keller, Emanuela
AU  - Keller E
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland; 
      Neurointensive Care Unit, Department of Neurosurgery, and Institute of Intensive 
      Care Medicine, Universitatsspital and University of Zurich, Zurich, Switzerland.
FAU - Regli, Luca
AU  - Regli L
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
FAU - van Doormaal, Tristan Pc
AU  - van Doormaal TP
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland; Department of 
      Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The 
      Netherlands; Department of Translational Neuroscience, University Medical Center 
      Utrecht, Brain Center, Utrecht University, Utrecht, The Netherlands.
FAU - Schaer, Dominik J
AU  - Schaer DJ
AD  - Division of Internal Medicine, Universitatsspital and University of Zurich, 
      Zurich, Switzerland.
FAU - Hugelshofer, Michael
AU  - Hugelshofer M
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
FAU - Akeret, Kevin
AU  - Akeret K
AD  - Department of Neurosurgery, Clinical Neuroscience Center, Universitatsspital und 
      University of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland. Electronic 
      address: kevin.akeret@usz.ch.
LA  - eng
PT  - Journal Article
DEP - 20230919
PL  - United States
TA  - J Stroke Cerebrovasc Dis
JT  - Journal of stroke and cerebrovascular diseases : the official journal of National 
      Stroke Association
JID - 9111633
SB  - IM
OTO - NOTNLM
OT  - Angiographic vasospasm
OT  - Delayed cerebral ischemia
OT  - Delayed ischemic neurologic deficit
OT  - Hemoglobin
OT  - Imaging
OT  - Secondary brain injury
COIS- Declaration of Competing Interest The authors declare the following financial 
      interests/personal relationships which may be considered as potential competing 
      interests: Raphael M Buzzi reports financial support was provided by Swiss 
      National Science Foundation. Dominik J Schaer reports financial support was 
      provided by Swiss National Science Foundation. Michael Hugelshofer reports 
      financial support was provided by Swiss National Science Foundation. Dominik 
      Schaer reports was provided by Innosuisse Swiss Innovation Agency. Kevin Akeret 
      reports was provided by Uniscientia Foundation. Raphael M Buzzi reports was 
      provided by University of Zurich. Kevin Akeret reports financial support was 
      provided by University of Zurich. Tristan PC van Doormaal reports a relationship 
      with AugmedIT B.V. that includes: board membership.
EDAT- 2023/09/22 00:42
MHDA- 2023/09/22 00:42
CRDT- 2023/09/21 18:04
PHST- 2023/06/08 00:00 [received]
PHST- 2023/09/08 00:00 [revised]
PHST- 2023/09/11 00:00 [accepted]
PHST- 2023/09/22 00:42 [pubmed]
PHST- 2023/09/22 00:42 [medline]
PHST- 2023/09/21 18:04 [entrez]
AID - S1052-3057(23)00380-4 [pii]
AID - 10.1016/j.jstrokecerebrovasdis.2023.107357 [doi]
PST - ppublish
SO  - J Stroke Cerebrovasc Dis. 2023 Nov;32(11):107357. doi: 
      10.1016/j.jstrokecerebrovasdis.2023.107357. Epub 2023 Sep 19.