Hajiahmadi Somayeh, Jafari Tuba, Naghavi Saba, Dashti Fatemeh
Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Al-Zahra Hospital, Isfahan, Iran.
Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Al-Zahra Hospital, Isfahan, Iran.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5674-5688. doi: 10.21037/qims-24-1299. Epub 2025 Jun 3.
Due to the high morbidity and mortality of primary intracerebral hemorrhage (ICH), several non-contrast computed tomography (NCCT) imaging markers were proposed to determine the prognosis of affected patients. We prospectively evaluated the predictive accuracy of certain imaging features and established a predictive model composed of highly relevant imaging and clinical features to identify the 3-month functional outcome in primary ICH patients.
Patients admitted for primary ICH to a tertiary care center (Al-Zahra Hospital, Isfahan, Iran) were prospectively included from September 2021 to October 2023. Inclusion criteria were defined as: Patients aged ≥18 years with primary or spontaneous ICH confirmed on NCCT at the time of admission. The baseline NCCT was conducted in the early stage of ICH (within 6 hours from symptom onset). The initial NCCT images were obtained within 6 hours from symptom onset. After 3 months, functional outcome of patients was assessed using the modified Rankin Scale (mRS); with mRS ≥3 as poor prognosis and mRS ≤2 as favorable prognosis. The Chi-squared and Logistic regression tests were used for determining the association between clinical and imaging features in differentiating patients' prognosis. Machine learning algorithm [support vector machine (SVM)] was also used to determine the importance rate of each relevant imaging sign in predicting prognosis.
A total of 203 primary ICH patients were included, among which 119 patients (58.6%) had unfavorable prognosis at 3 months. Age, diastolic blood pressure, and Glasgow Coma Scale (GCS) score at admission were significantly associated with prognosis. Among imaging features, hemorrhage volume [95% confidence interval (CI): 0.972-0.991, P<0.001], the presence of midline shift (95% CI: 2.038-7.911, P<0.001), blend sign (95% CI: 1.081-3.760, P=0.026), satellite sign (95% CI: 1.451-4.764, P=0.001), and black hole sign (95% CI: 2.262-12.714, P<0.001) were significantly different among 2 groups. SVM algorithm showed hemorrhage volume the most important prognostic imaging feature (importance rate: 100%), along with black hole (63.1%), midline shift (54%), satellite (20.4%), and blend sign (15.6%); with decreasing order of importance.
Using certain radiological and clinical features, we established a model with considerable prognostication in management of patients with primary ICH in emergency departments.
由于原发性脑出血（ICH）的高发病率和高死亡率，人们提出了几种非增强计算机断层扫描（NCCT）成像标志物来确定受影响患者的预后。我们前瞻性地评估了某些成像特征的预测准确性，并建立了一个由高度相关的成像和临床特征组成的预测模型，以识别原发性ICH患者3个月后的功能结局。
2021年9月至2023年10月，前瞻性纳入在三级医疗中心（伊朗伊斯法罕的阿尔-扎赫拉医院）因原发性ICH入院的患者。纳入标准定义为：年龄≥18岁，入院时经NCCT确诊为原发性或自发性ICH。在ICH早期（症状发作后6小时内）进行基线NCCT。初始NCCT图像在症状发作后6小时内获得。3个月后，使用改良Rankin量表（mRS）评估患者的功能结局；mRS≥3为预后不良，mRS≤2为预后良好。采用卡方检验和逻辑回归检验确定临床和影像学特征与区分患者预后之间的关联。还使用机器学习算法[支持向量机（SVM）]来确定每个相关影像学征象在预测预后中的重要性率。
共纳入203例原发性ICH患者，其中119例（58.6%）在3个月时预后不良。年龄、舒张压和入院时的格拉斯哥昏迷量表（GCS）评分与预后显著相关。在影像学特征中，两组间血肿体积[95%置信区间（CI）：0.972 - 0.991，P<0.001]、中线移位的存在（95% CI：2.038 - 7.911，P<0.001）、混合征（95% CI：1.081 - 3.760，P = 0.026）、卫星征（95% CI：1.451 - 4.764，P = 0.001）和黑洞征（95% CI：2.262 - 12.714，P<0.001）有显著差异。SVM算法显示血肿体积是最重要的预后影像学特征（重要性率：100%），其次是黑洞征（63.1%）、中线移位（54%）、卫星征（20.4%）和混合征（15.6%）；按重要性降序排列。
利用某些放射学和临床特征，我们建立了一个在急诊科对原发性ICH患者管理中具有相当预后价值的模型。
