Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis
Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis
复制标题
DOI：
10.3171/2014.10.jns141429
复制
发表时间：
2015-07-01
影响因子：
4.1
通讯作者：
Nagahiro, Shinji
中科院分区：
文献类型：
--
作者：
Satomi, Junichiro;Ghaibeh, A. Ammar;Nagahiro, Shinji
目的颅硬膜动静脉瘘（DAVFs）的临床体征和症状的严重程度与其静脉引流方式密切相关。虽然皮质静脉引流的存在可以被认为是侵袭性DAVF行为的潜在预测因素，如颅内出血或由于静脉充血导致的进行性神经功能缺损，但目前还没有准确的统计分析。采用决策树数据挖掘方法，旨在明确DAVF攻击行为未来发展的可预测性，并确定其主要致病因素。方法266例DAVF患者中，89例符合分析条件。在观察管理下，51例患者在随访期间出现颅内出血/梗死。结果：作者创建了一个决策树，能够评估攻击性DAVF行为发展的风险。经10倍交叉验证，该决策树的准确率、灵敏度和特异性分别为85.28%、88.33%和80.83%。树状图显示，有症状患者的主要因素是存在皮质静脉引流。如果没有，病变位置决定了DAVF发展为攻击行为的风险。结论决策树分析法能准确预测患者攻击性DAVF行为的未来发展。
OBJECT The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors.METHODS Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period.RESULTS The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior.CONCLUSIONS Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.