External validation of the diagnostic value of perihematomal edema characteristics in neoplastic and non-neoplastic intracerebral hemorrhage

Jawed Nawabi; Tobias Orth; Sophia Schulze-Weddige; Georg Lukas Baumgaertner; Anna Tietze; Christian Thaler; Tobias Penzkofer

doi:10.1111/ene.15760

External validation of the diagnostic value of perihematomal edema characteristics in neoplastic and non-neoplastic intracerebral hemorrhage

Eur J Neurol. 2023 Jun;30(6):1686-1695. doi: 10.1111/ene.15760. Epub 2023 Mar 23.

Authors

Jawed Nawabi^{1

2}, Tobias Orth¹, Sophia Schulze-Weddige³, Georg Lukas Baumgaertner³, Anna Tietze⁴, Christian Thaler⁵, Tobias Penzkofer^{2

3}

Affiliations

¹ Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
² Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.
³ Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
⁴ Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.
⁵ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.

PMID: 36847734
DOI: 10.1111/ene.15760

Abstract

Background and purpose: Neoplastic intracerebral hemorrhage (ICH) may be incorrectly identified as non-neoplastic ICH on imaging. Relative perihematomal edema (relPHE) on computed tomography (CT) has been proposed as a marker to discriminate neoplastic from non-neoplastic ICH but has not been externally validated. The purpose of this study was to evaluate the discriminatory power of relPHE in an independent cohort.

Methods: A total of 291 patients with acute ICH on CT and follow-up magnetic resonance imaging (MRI) were included in this single-center retrospective study. ICH subjects were dichotomized into non-neoplastic or neoplastic ICH based on the diagnosis on the follow-up MRI. ICH and PHE volumes and density values were derived from semi-manually segmented CT scans. Calculated PHE characteristics for discriminating neoplastic ICH were evaluated using receiver-operating characteristic (ROC) curves. ROC curve-associated cut-offs were calculated and compared between the initial and the validation cohort.

Results: A total of 116 patients (39.86%) with neoplastic ICH and 175 (60.14%) with non-neoplastic ICH were included. Median PHE volumes, relPHE, and relPHE adjusted for hematoma density were significantly higher in subjects with neoplastic ICH (all p values <0.001). ROC curves for relPHE had an area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.66-0.78) and an AUC of 0.81 (95% CI 0.76-0.87) for adjusted relPHE. The cut-offs were identical in the two cohorts, with >0.70 for relPHE and >0.01 for adjusted relPHE.

Conclusions: Relative perihematomal edema and adjusted relPHE accurately discriminated neoplastic from non-neoplastic ICH on CT imaging in an external patient cohort. These results confirmed the findings of the initial study and may improve clinical decision making.

Keywords: brain tumor; computed tomography; intracerebral hemorrhage; metastases; perihematomal edema.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Edema* / diagnostic imaging
Brain Edema* / etiology
Cerebral Hemorrhage / complications
Cerebral Hemorrhage / diagnostic imaging
Cerebral Hemorrhage / pathology
Edema / diagnostic imaging
Edema / etiology
Hematoma / diagnostic imaging
Hematoma / pathology
Humans
Magnetic Resonance Imaging
Retrospective Studies