RT Journal Article
SR Electronic
T1 Quantitative Shape Irregularity and Density Heterogeneity of Preoperative Hematoma Can Predict Rebleeding following Minimally Invasive Catheter Evacuation for Intracerebral Hemorrhage
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8680
A1 Kang, Kaijiang
A1 Ji, Zeqiang
A1 Du, Yang
A1 Li, Guangshuo
A1 Yan, Jing
A1 Ding, Zeyu
A1 Shi, Yiming
A1 Liu, Yanfang
A1 Wu, Jianwei
A1 Zhao, Xingquan
YR 2025
UL http://www.ajnr.org/content/early/2025/06/12/ajnr.A8680.abstract
AB BACKGROUND AND PURPOSE: Postoperative rebleeding is a critical factor associated with poor outcomes in patients with intracerebral hemorrhage (ICH) who undergo minimally invasive catheter evacuation (MICE) followed by thrombolysis. This study aimed to explore the association between quantitative shape irregularity and density heterogeneity of preoperative hematoma and rebleeding after MICE.MATERIALS AND METHODS: We analyzed patients with ICH who underwent MICE between February 2021 and January 2024. The surface regularity index (SRI) and density coefficient of variation (DCV) of the hematomas were obtained based on preoperative CT by using 3D Slicer software. Postoperative rebleeding was defined as a hematoma increase of >6 mL or >33% compared with the previous CT. The predictive value of shape irregularity (reflected by SRI) and density heterogeneity (reflected by DCV) for postoperative rebleeding were comprehensively analyzed.RESULTS: In total, 240 patients were included, of whom 45 (18.8%) experienced postoperative rebleeding. Patients with postoperative rebleeding exhibited lower SRI (37.2 versus 51.4, P = .001) and higher DCV (13.8% versus 11.7%, P < .001) after adjusting for preoperative hematoma volume, surface area, standard deviation of hematoma density, intraventricular hemorrhage (IVH), hematoma expansion (HE), time period from onset to surgery, and catheter misplacement. The combination of SRI, DCV, IVH, and HE demonstrated optimal discrimination in predicting postoperative rebleeding, with an area under the curve (AUC) and 95% CI of 0.880 (0.824–0.935).CONCLUSIONS: Hematoma shape irregularity and density heterogeneity are risk factors for rebleeding after MICE for ICH. SRI and DCV can be used to identify individuals at high risk of postoperative rebleeding.AUCarea under the curveDCVdensity coefficient of variationHEhematoma expansionICHintracerebral hemorrhageIQRinterquartile rangeIVHintraventricular hemorrhageMICEminimally invasive catheter evacuationORodds ratioROCreceiver operating characteristicSRIsurface regularity index