Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.
Eur J Neurol. 2023 Jun;30(6):1686-1695. doi: 10.1111/ene.15760. Epub 2023 Mar 23.
Neoplastic intracerebral hemorrhage (ICH) may be incorrectly identified as non-neoplastic ICH on imaging. Relative perihematomal edema (relPHE) on computed tomography (CT) has been proposed as a marker to discriminate neoplastic from non-neoplastic ICH but has not been externally validated. The purpose of this study was to evaluate the discriminatory power of relPHE in an independent cohort.
A total of 291 patients with acute ICH on CT and follow-up magnetic resonance imaging (MRI) were included in this single-center retrospective study. ICH subjects were dichotomized into non-neoplastic or neoplastic ICH based on the diagnosis on the follow-up MRI. ICH and PHE volumes and density values were derived from semi-manually segmented CT scans. Calculated PHE characteristics for discriminating neoplastic ICH were evaluated using receiver-operating characteristic (ROC) curves. ROC curve-associated cut-offs were calculated and compared between the initial and the validation cohort.
A total of 116 patients (39.86%) with neoplastic ICH and 175 (60.14%) with non-neoplastic ICH were included. Median PHE volumes, relPHE, and relPHE adjusted for hematoma density were significantly higher in subjects with neoplastic ICH (all p values <0.001). ROC curves for relPHE had an area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.66-0.78) and an AUC of 0.81 (95% CI 0.76-0.87) for adjusted relPHE. The cut-offs were identical in the two cohorts, with >0.70 for relPHE and >0.01 for adjusted relPHE.
Relative perihematomal edema and adjusted relPHE accurately discriminated neoplastic from non-neoplastic ICH on CT imaging in an external patient cohort. These results confirmed the findings of the initial study and may improve clinical decision making.
在影像学上，肿瘤性脑内出血（ICH）可能被错误地识别为非肿瘤性 ICH。CT 上的相对血肿周围水肿（relPHE）已被提出作为区分肿瘤性和非肿瘤性 ICH 的标志物，但尚未经过外部验证。本研究的目的是在一个独立的队列中评估 relPHE 的鉴别能力。
本单中心回顾性研究共纳入 291 例 CT 检查发现急性 ICH 且有随访 MRI 的患者。根据随访 MRI 诊断，将 ICH 患者分为非肿瘤性或肿瘤性 ICH。从半手动分割 CT 扫描中得出 ICH 和 PHE 体积及密度值。使用受试者工作特征（ROC）曲线评估用于区分肿瘤性 ICH 的 PHE 特征。计算 ROC 曲线相关的截断值，并在初始和验证队列中进行比较。
共纳入 116 例（39.86%）肿瘤性 ICH 患者和 175 例（60.14%）非肿瘤性 ICH 患者。肿瘤性 ICH 患者的 PHE 体积、relPHE 和调整血肿密度后的 relPHE 中位数均显著更高（所有 p 值均<0.001）。relPHE 的 ROC 曲线下面积（AUC）为 0.72（95%置信区间[CI] 0.66-0.78），调整后的 relPHE 的 AUC 为 0.81（95% CI 0.76-0.87）。两个队列的截断值相同，relPHE >0.70，调整后的 relPHE >0.01。
在外部患者队列中，相对血肿周围水肿和调整后的 relPHE 在 CT 成像上能准确区分肿瘤性和非肿瘤性 ICH。这些结果证实了初始研究的发现，可能有助于临床决策。
