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Phantom-based standardization of CT angiography images for spot sign detection.
Morotti, Andrea; Romero, Javier M; Jessel, Michael J; Hernandez, Andrew M; Vashkevich, Anastasia; Schwab, Kristin; Burns, Joseph D; Shah, Qaisar A; Bergman, Thomas A; Suri, M Fareed K; Ezzeddine, Mustapha; Kirmani, Jawad F; Agarwal, Sachin; Shapshak, Angela Hays; Messe, Steven R; Venkatasubramanian, Chitra; Palmieri, Katherine; Lewandowski, Christopher; Chang, Tiffany R; Chang, Ira; Rose, David Z; Smith, Wade; Hsu, Chung Y; Liu, Chun-Lin; Lien, Li-Ming; Hsiao, Chen-Yu; Iwama, Toru; Afzal, Mohammad Rauf; Cassarly, Christy; Greenberg, Steven M; Martin, Renee' Hebert; Qureshi, Adnan I; Rosand, Jonathan; Boone, John M; Goldstein, Joshua N.
Affiliation
  • Morotti A; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. a.morotti@ymail.com.
  • Romero JM; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA. a.morotti@ymail.com.
  • Jessel MJ; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
  • Hernandez AM; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
  • Vashkevich A; Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Schwab K; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
  • Burns JD; Department of Radiology, University of California Davis, Sacramento, CA, USA.
  • Shah QA; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
  • Bergman TA; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
  • Suri MFK; Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA.
  • Ezzeddine M; Abington Memorial Hospital, Abington, PA, USA.
  • Kirmani JF; Hennepin County Medical Center, Minneapolis, MN, USA.
  • Agarwal S; St. Cloud Hospital, St. Cloud, MN, USA.
  • Shapshak AH; University of Minnesota, Minneapolis, MN, USA.
  • Messe SR; Stroke & Neurovascular Center, JFK Medical Center, Edison, NJ, USA.
  • Venkatasubramanian C; Columbia University Medical Center, New York, NY, USA.
  • Palmieri K; University of Alabama at Birmingham, Birmingham, AL, USA.
  • Lewandowski C; University of Pennsylvania, Philadelphia, PA, USA.
  • Chang TR; Stanford University, Stanford, CA, USA.
  • Chang I; The University of Kansas Health System, Kansas City, KS, USA.
  • Rose DZ; Henry Ford Hospital, Detroit, MI, USA.
  • Smith W; University of Texas Medical School, Houston, TX, USA.
  • Hsu CY; Colorado Neurological Institute, Swedish Medical Center, Englewood, CO, USA.
  • Liu CL; Tampa General Hospital, University of South Florida College of Medicine, Tampa, FL, USA.
  • Lien LM; UCSF Medical Center, San Francisco, CA, USA.
  • Hsiao CY; China Medical University Hospital, Taichung, Taiwan.
  • Iwama T; China Medical University Hospital, Taichung, Taiwan.
  • Afzal MR; Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
  • Cassarly C; Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
  • Greenberg SM; Gifu University Hospital, Gifu, Japan.
  • Martin RH; Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA.
  • Qureshi AI; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
  • Rosand J; J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
  • Boone JM; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
  • Goldstein JN; Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA.
Neuroradiology ; 59(9): 839-844, 2017 Sep.
Article in En | MEDLINE | ID: mdl-28730267
ABSTRACT

PURPOSE:

The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance.

METHODS:

A custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%.

RESULTS:

A total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8 vs 38.9% p < 0.001). All spot signs identified in the non-calibrated analysis remained positive after calibration. Calibrated CTA images had higher sensitivity for ICH expansion (76 vs 52%) but inferior specificity (35 vs 63%) compared with uncalibrated images.

CONCLUSION:

Normalization of CTA images using phantom data is a feasible strategy to obtain consistent image quantification for spot sign analysis across different sites and may improve sensitivity for identification of ICH expansion.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cerebral Hemorrhage / Computed Tomography Angiography / Hematoma Type of study: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies Limits: Humans Language: En Journal: Neuroradiology Year: 2017 Type: Article Affiliation country: United States
Fulltext
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cerebral Hemorrhage / Computed Tomography Angiography / Hematoma Type of study: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies Limits: Humans Language: En Journal: Neuroradiology Year: 2017 Type: Article Affiliation country: United States