Purpose: Hematoma expansion (HE) for patients with intracerebral hemorrhage (ICH) has been shown to be a predictor of clinical neurological deterioration in ICH patients. As of now, there is no diagnosis which may indicate HE at the time of presentation. In this study, a Random Forest-based machine learning model with clinical data from ICH patients was developed and used as input to predict HE. Materials and Methods: 200 ICH patients with known hematoma evolution, were enrolled in this study. Data included brain volume, and hematoma volume based on non-contrast CT (NCCT) measurements; and the following patient specific clinical variables: age, sex, Glasgow Coma Scale score (GCS), ICH score, NIH Stroke Scale (NIHSS) and time from onset of ICH to initial NCCT. Random Forest machine learning model was developed to predict HE using 104/26 subjects training/testing split. Grid search strategy tuned the classifier parameters and a 5-fold cross-validation approach was used during training. The performance of model was evaluated by sensitivity, specificity, and Area Under the Curve (AUC). Results: The developed Random Forest model was able to predict HE with sensitivity of 0.846, specificity of 0.769, AUC of 0.807. Hematoma volume and time from onset of ICH to initial NCCT were the most important features, followed by NIHSS and brain volume. Conclusion: A Random Forest-based machine learning model with multiple clinical data from ICH patients as input performed well in predicting HE. Brain volume may be a new predictor of hematoma expansion.
KEYWORDS: Magnetic resonance imaging, Lawrencium, Feature extraction, Medical imaging, Image segmentation, Computed tomography, Systems modeling, Process modeling, Monte Carlo methods, Data acquisition
Purpose: Intracranial hemorrhage (ICH) is characterized as bleeding into the brain tissue, intracranial space, and ventricles and is the second most disabling form of stroke. Hematoma expansion (HE) following ICH has been correlated with significant neurological decline and death. For early detection of patients at risk, deep learning prediction models were developed to predict whether hematoma due to ICH will expand. This study aimed to explore the feasibility of HE prediction using a radiomic approach to help clinicians better stratify HE patients and tailor intensive therapies timely and effectively. Materials and Methods: Two hundred ICH patients with known hematoma evolution, were enrolled in this study. An open-source python package was utilized for the extraction of radiomic features from both non-contrast computed tomography (NCCT) and magnetic resonance imaging (MRI) scans through characterization algorithms. A total of 99 radiomic features were extracted and different features were selected for network inputs for the NCCT and MR models. Seven supervised classifiers: Support Vector Machine, Naïve Bayes, Decision Tree, Random Forest, Logistic Regression, K-Nearest Neighbor and Multilayer Perceptron were used to build the models. A training:testing split of 80:20 and 20 iterations of Monte Carlo cross validation were performed to prevent overfitting and assess the variability of the networks, respectively. The models were fed training datasets from which they learned to classify the data based on pre-determined radiomic categories. Results: The highest sensitivity among the NCCT classifier models was seen with the support vector machine (SVM) and logistic regression (LR) of 72 ± 0.3% and 73 ± 0.5%, respectively. The MRI classifier models had the highest sensitivity of 68 ± 0.5% and 72 ± 0.5% for the SVM and LR models, respectively. Conclusions: This study indicates that the NCCT radiomics model is a better predictor of HE and that SVM and LR classifiers are better predictors of HE due to their more cautious approach indicated by a higher sensitivity metric.
Purpose: Intracerebral Hemorrhage (ICH) is one of the most devastating types of strokes with mortality and morbidity rates ranging from about 51%-65% one year after diagnosis. Early hematoma expansion (HE) is a known cause of worsening neurological status of ICH patients. The goal of this study was to investigate whether non-contrast computed tomography imaging biomarkers (NCCT-IB) acquired at initial presentation can predict ICH growth in the acute stage. Materials and Methods: We retrospectively collected NCCT data from 326 patients with acute (<6 hours) ICH. Four NCCT-IBs (blending region, dark hole, island, and edema) were identified for each hematoma, respectively. HE status was recorded based on the clinical observation reported in the patient chart. Supervised machine learning models were developed, trained, and tested for 15 different input combinations of the NCCT-IBs to predict HE. Model performance was assessed using area under the receiver operating characteristic curve and probability for accurate diagnosis (PAD) was calculated. A 20-fold Monte-Carlo cross validation was implemented to ensure model reliability on a limited sample size of data, by running a myriad of random training/testing splits. Results: The developed algorithm was able to predict expansion utilizing all four inputs with an accuracy of 70.17%. Further testing of all biomarker combinations yielded PAD ranging from 0.57, to 0.70. Conclusion: Specific attributes of ICHs may influence the likelihood of HE and can be evaluated via a machine learning algorithm. However, certain parameters may differ in importance to reach accurate conclusions about potential expansion.
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