Diagnostic Accuracy and Reliability of Noncontrast Computed Tomography Markers for Acute Hematoma Expansion among Radiologists
Hawra Almubarak,
Sarah Elsayed,
Federico Mazzacane,
Frieder Schlunk,
Haoyin Cao,
Ly Huong Vu,
Estelle Vogt,
Andrea Dell Orco,
Dmitriy Desser,
Maik F. H. Böhmer,
Burak Han Akkurt,
Peter B. Sporns,
Tobias Penzkofer,
Uta Hanning,
Andrea Morotti,
Jawed Nawabi
Affiliations
Hawra Almubarak
Department of Radiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Sarah Elsayed
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20251 Hamburg, Germany
Federico Mazzacane
Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
Frieder Schlunk
Department of Neuroradiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Haoyin Cao
Department of Radiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Ly Huong Vu
Department of Radiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Estelle Vogt
Department of Radiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Andrea Dell Orco
Department of Neuroradiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Dmitriy Desser
Department of Neuroradiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Maik F. H. Böhmer
Department of Radiology, University Hospital Muenster, 48149 Muenster, Germany
Burak Han Akkurt
Department of Radiology, University Hospital Muenster, 48149 Muenster, Germany
Peter B. Sporns
Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
Tobias Penzkofer
Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, 10117 Berlin, Germany
Uta Hanning
Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, 20251 Hamburg, Germany
Andrea Morotti
Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, 25123 Brescia, Italy
Jawed Nawabi
Department of Radiology (CCM), Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, 10117 Berlin, Germany
Background: Noncontrast Computed Tomography (NCCT) features are promising markers for acute hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH). It remains unclear whether accurate identification of these markers is also reliable in raters with different levels of experience. Methods: Patients with acute spontaneous ICH admitted at four tertiary centers in Germany and Italy were retrospectively included from January 2017 to June 2020. In total, nine NCCT markers were rated by one radiology resident, one radiology fellow, and one neuroradiology fellow with different levels experience in ICH imaging. Interrater reliabilities of the resident and radiology fellow were evaluated by calculated Cohen’s kappa (κ) statistics in reference to the neuroradiology fellow who was referred as the gold standard. Gold-standard ratings were evaluated by calculated interrater κ statistics. Global interrater reliabilities were evaluated by calculated Fleiss kappa statistics across all three readers. A comparison of receiver operating characteristics (ROCs) was used to evaluate differences in the diagnostic accuracy for predicting acute hematoma expansion (HE) among the raters. Results: Substantial-to-almost-perfect interrater concordance was found for the resident with interrater Cohen’s kappa from 0.70 (95% CI 0.65–0.81) to 0.96 (95% CI 0.94–0.98). The interrater Cohen’s kappa for the radiology fellow was moderate to almost perfect and ranged from 0.58 (95% CI 0.52–0.65) to 94 (95% CI 92–0.97). The intrarater gold-standard Cohen’s kappa was almost perfect and ranged from 0.79 (95% CI 0.78–0.90) to 0.98 (95% CI 0.78–0.90). The global interrater Fleiss kappa ranged from 0.62 (95%CI 0.57–0.66) to 0.93 (95%CI 0.89–0.97). The diagnostic accuracy for the prediction of acute hematoma expansion (HE) was different for the island sign and fluid sign, with p-values < 0.05. Conclusion: The NCCT markers had a substantial-to-almost-perfect interrater agreement among raters with different levels of experience. Differences in the diagnostic accuracy for the prediction of acute HE were found in two out of nine NCCT markers. The study highlights the promising utility of NCCT markers for acute HE prediction.
