Predicting Hematoma Expansion and Prognosis in Cerebral Contusions: A Radiomics-Clinical Approach

作者全名："He, Haoyue; Liu, Jinxin; Li, Chuanming; Guo, Yi; Liang, Kaixin; Du, Jun; Xue, Jun; Liang, Yidan; Chen, Peng; Liu, Liu; Cui, Min; Wang, Jia; Liu, Ye; Tian, Shanshan; Deng, Yongbing"

作者地址："[He, Haoyue; Liu, Jinxin; Liang, Yidan; Chen, Peng; Liu, Liu; Cui, Min; Wang, Jia; Liu, Ye; Deng, Yongbing] Chongqing Univ Cent Hosp, Chongqing Emergency Med Ctr, Dept Neurosurg, Chongqing, Peoples R China; [Li, Chuanming; Guo, Yi] Chongqing Univ Cent Hosp, Chongqing Emergency Med Ctr, Med Imaging Dept, Chongqing, Peoples R China; [Tian, Shanshan] Chongqing Univ Cent Hosp, Chongqing Emergency Med Ctr, Dept Prehosp Emergency, Chongqing, Peoples R China; [He, Haoyue] Chongqing Univ, Bioengn Coll, Chongqing, Peoples R China; [Liu, Jinxin; Liu, Ye] Chongqing Univ, Sch Med, Chongqing, Peoples R China; [Liang, Kaixin] Yubei Dist Hosp Tradit Chinese Med, Dept Neurosurg, Chongqing, Peoples R China; [Du, Jun] Chongqing Univ, Chongqing Qianjiang Cent Hosp, Qianjiang Hosp, Dept Neurosurg, Chongqing, Peoples R China; [Xue, Jun] Chongqing Med Univ, Bishan Hosp Chongqing, Bishan Hosp, Dept Neurosurg, Chongqing, Peoples R China; [Deng, Yongbing] Chongqing Emergency Med Ctr, Dept Neurosurg, 1 Hlth Rd, Chongqing 400014, Peoples R China"

通信作者："Deng, YB (通讯作者)，Chongqing Emergency Med Ctr, Dept Neurosurg, 1 Hlth Rd, Chongqing 400014, Peoples R China."

来源：JOURNAL OF NEUROTRAUMA

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:001175457800001

JCR分区：Q2

影响因子：4.2

年份：2024

卷号：41

期号：11月12日

开始页：1337

结束页：1352

文献类型：Article

关键词：automatic segmentation; cerebral contusion; hematoma expansion; radiomics; traumatic brain injury

摘要："Hemorrhagic progression of contusion (HPC) often occurs early in cerebral contusions (CC) patients, significantly impacting their prognosis. It is vital to promptly assess HPC and predict outcomes for effective tailored interventions, thereby enhancing prognosis in CC patients. We utilized the Attention-3DUNet neural network to semi-automatically segment hematomas from computed tomography (CT) images of 452 CC patients, incorporating 695 hematomas. Subsequently, 1502 radiomic features were extracted from 358 hematomas in 261 patients. After a selection process, these features were used to calculate the radiomic signature (Radscore). The Radscore, along with clinical features such as medical history, physical examinations, laboratory results, and radiological findings, was employed to develop predictive models. For prognosis (discharge Glasgow Outcome Scale score), radiomic features of each hematoma were augmented and fused for correlation. We employed various machine learning methodologies to create both a combined model, integrating radiomics and clinical features, and a clinical-only model. Nomograms based on logistic regression were constructed to visually represent the predictive procedure, and external validation was performed on 170 patients from three additional centers. The results showed that for HPC, the combined model, incorporating hemoglobin levels, Rotterdam CT score of 3, multi-hematoma fuzzy sign, concurrent subdural hemorrhage, international normalized ratio, and Radscore, achieved area under the receiver operating characteristic curve (AUC) values of 0.848 and 0.836 in the test and external validation cohorts, respectively. The clinical model predicting prognosis, utilizing age, Abbreviated Injury Scale for the head, Glasgow Coma Scale Motor component, Glasgow Coma Scale Verbal component, albumin, and Radscore, attained AUC values of 0.846 and 0.803 in the test and external validation cohorts, respectively. Selected radiomic features indicated that irregularly shaped and highly heterogeneous hematomas increased the likelihood of HPC, while larger weighted axial lengths and lower densities of hematomas were associated with a higher risk of poor prognosis. Predictive models that combine radiomic and clinical features exhibit robust performance in forecasting HPC and the risk of poor prognosis in CC patients. Radiomic features complement clinical features in predicting HPC, although their ability to enhance the predictive accuracy of the clinical model for adverse prognosis is limited."

基金机构："Fundamental Research Funds for the Central Universities [2023CDJYGRH-ZD06]; Natural Science Foundation Project of Chongqing Science and Technology Commission [cstc2020jcyj-msxmX0769]; Project of Science and Technology Bureau of Yuzhong District, Chongqing [20200135]"

基金资助正文："This work was supported by the Fundamental Research Funds for the Central Universities (2023CDJYGRH-ZD06); by the Natural Science Foundation Project of Chongqing Science and Technology Commission (cstc2020jcyj-msxmX0769); by the Project of Science and Technology Bureau of Yuzhong District, Chongqing (20200135)."