Automated Quantification of Compartmental Blood Volumes Enables Prediction of Delayed Cerebral Ischemia and Outcomes After Aneurysmal Subarachnoid Hemorrhage.
Automated Quantification of Compartmental Blood Volumes Enables Prediction of Delayed Cerebral Ischemia and Outcomes After Aneurysmal Subarachnoid Hemorrhage.
复制标题
室室血容量的自动定量可以预测迟发性脑缺血和动脉瘤性蛛网膜下腔出血后的结果。
DOI：
10.1016/j.wneu.2022.10.105
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发表时间：
2023
影响因子：
2
通讯作者：
Dhar,Rajat
中科院分区：
文献类型：
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作者：
Yuan,JaneY;Chen,Yasheng;Jayaraman,Keshav;Kumar,Atul;Zlepper,Zach;Allen,MichelleL;Athiraman,Umeshkumar;Osbun,Joshua;Zipfel,Gregory;Dhar,Rajat
目的 出血量在血管痉挛、迟发性脑缺血 (DCI) 和动脉瘤性蛛网膜下腔出血 (SAH) 后不良预后风险中的作用已得到充分证实。然而，血液在各个隔室内的相对贡献尚不清楚。我们提出了一种自动化技术，不仅可以测量 SAH 后每个主要隔室的血液总量，还可以测量其体积。方法我们训练卷积神经网络，从 SAH 患者的基线计算机断层扫描中识别隔室血液（脑池、脑沟和心室）。我们将 190 名 SAH 患者的自动血容量与传统出血标记（改良 Fisher 评分 [mFS]、Hijdra 总评分 [HSS]）进行比较，以预测出院时的血管痉挛、DCI 和功能状态（改良 Rankin 量表）。结果脑池和脑沟容量的组合与 mFS 和 HSS 的相关性比单独的脑池容量更好（ρ = 0.63 vs. 0.58 和 0.75）与 0.70，P < 0.001）。在调整临床因素后，只有脑池和脑沟组合的血容量与 DCI 独立相关（OR 1.023/mL，95% CI 1.002–1.048），而心室血容量则不然。脑沟总血容量和具体脑沟血容量与不良结果密切相关（脑沟 OR 1.03，1.01–1.06，P= 0.006；脑沟 OR 1.04，1.00–1.08），HSS 也是如此（OR 1.06 每点，1.00–1.12，P= 0.04），而 mFS 则不然（P= 0.24).结论自动成像算法可以测量 SAH 后各个脑室内的出血量，证明脑池加脑沟（而不是心室）血液会增加 DCI/血管痉挛的风险。自动血容量与结果独立相关，而定性分级则不然。
ObjectiveThe role of hemorrhage volume in risk of vasospasm, delayed cerebral ischemia (DCI), and poor outcomes after aneurysmal subarachnoid hemorrhage (SAH) is well established. However, the relative contribution of blood within individual compartments is unclear. We present an automated technique for measuring not only total but also volumes of blood in each major compartment after SAH.MethodsWe trained convolutional neural networks to identify compartmental blood (cisterns, sulci, and ventricles) from baseline computed tomography scans of patients with SAH. We compared automated blood volumes against traditional markers of bleeding (modified Fisher score [mFS], Hijdra sum score [HSS]) in 190 SAH patients for prediction of vasospasm, DCI, and functional status (modified Rankin Scale) at hospital discharge.ResultsCombined cisternal and sulcal volume was better correlated with mFS and HSS than cisternal volume alone (ρ = 0.63 vs. 0.58 and 0.75 vs. 0.70,P< 0.001). Only blood volume in combined cisternal plus sulcal compartments was independently associated with DCI (OR 1.023 per mL, 95% CI 1.002–1.048), after adjusting for clinical factors while ventricular blood volume was not. Total and specifically sulcal blood volume was strongly associated with poor outcome (OR 1.03 per mL, 1.01–1.06,P= 0.006 and OR 1.04, 1.00–1.08 for sulcal) as was HSS (OR 1.06 per point, 1.00–1.12,P= 0.04), while mFS was not (P= 0.24).ConclusionsAn automated imaging algorithm can measure the volume of bleeding after SAH within individual compartments, demonstrating cisternal plus sulcal (and not ventricular) blood contributes to risk of DCI/vasospasm. Automated blood volume was independently associated with outcome, while qualitative grading was not.