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A critical step in detection of primary intracerebral haemorrhage (ICH) is an accurate assessment of computed tomography (CT) brain images. The correct diagnosis relies on imaging modality and quality of acquired images. The authors present an enhancement algorithm which can improve the clarity of edges on CT images. About 40 samples of CT brain images with final diagnosis of primary ICH were obtained from the UKM Medical Centre in Digital Imaging and Communication in Medicine format. The images resized from 512 × 512 to 256 × 256 pixel resolution to reduce processing time. This Letter comprises of two main sections; the first is denoising using Wiener filter, non-local means and wavelet; the second section focuses on image enhancement using a modified unsharp masking (UM) algorithm to improve the visualisation of ICH. The combined approach of Wiener filter and modified UM algorithm outperforms other combinations with average values of mean square error, peak signal-to-noise ratio, variance and structural similarity index of 2.89, 31.72, 0.12 and 0.98, respectively. The reliability of proposed algorithm was evaluated by three blinded assessors which achieved a median score of 65%. This approach provides reliable validation for the proposed algorithm which has potential in improving image analysis.
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INTRODUCTION: The Anti-fibrinolytics Trialists Collaboration aims to increase knowledge about the effectiveness and safety of anti-fibrinolytic treatment by conducting individual patient data (IPD) meta-analyses of randomised trials. This article presents the statistical analysis plan for an IPD meta-analysis of the effects of anti-fibrinolytics for acute intracranial haemorrhage. METHODS: The protocol for the IPD meta-analysis has been registered with PROSPERO (CRD42019128260). We will conduct an individual patient data meta-analysis of randomised controlled trials with 500 patients or more assessing the effects of anti-fibrinolytics in acute intracranial haemorrhage. The primary outcomes will be 1) death from stroke or head injury within 30 days of randomisation, and 2) death from stroke or head injury, or dependency within 90 days of randomisation. The primary outcomes will be limited to patients treated within three hours of injury or stroke onset. We will report treatment effects using odds ratios and 95% confidence intervals. We use logistic regression models to examine how the effect of anti-fibrinolytics vary by time to treatment, severity of intracranial bleeding, and age. We will also examine the effect of anti-fibrinolytics on secondary outcomes including death, dependency, vascular occlusive events, seizures, and neurological outcomes. Secondary outcomes will be assessed in all patients irrespective of time of treatment. All analyses will be conducted on an intention-to-treat basis. CONCLUSIONS: This IPD meta-analysis will examine important clinical questions about the effects of anti-fibrinolytic treatment in patients with intracranial haemorrhage that cannot be answered using aggregate data. With IPD we can examine how effects vary by time to treatment, bleeding severity, and age, to gain better understanding of the balance of benefit and harms on which to base recommendations for practice.
