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Radiomics for intracerebral hemorrhage: are all small hematomas benign?

OBJECTIVES
We hypothesized that not all small hematomas are benign and that radiomics could predict hematoma expansion (HE) and short-term outcomes in small hematomas.


METHODS
We analyzed 313 patients with small (<10 ml) intracerebral hemorrhage (ICH) who underwent baseline non-contrast CT within 6 h of symptom onset between September 2013 and February 2019. Poor outcome was defined as a Glasgow Outcome Scale score ≤3. A radiomic model and a clinical model were built using least absolute shrinkageand selection operator algorithm or multivariate analysis. A combined model that incorporated the developed radiomic score and clinical factors was then constructed. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models.


RESULTS
The addition of radiomics to clinical factors significantly improved the prediction performance of HE compared with the clinical model alone in both the training {AUC, 0.762 [95% CI (0.665-0.859)] versus AUC, 0.651 [95% CI (0.556-0.745)], p = 0.007} and test {AUC, 0.776 [95% CI (0.655-0.897) versus AUC, 0.631 [95% CI (0.451-0.810)], p = 0.001} cohorts. Moreover, the radiomic-based model achieved good discrimination ability of poor outcomes in the 3-10 ml group (AUCs 0.720 and 0.701).


CONCLUSION
Compared with clinical information alone, combined model had greater potential for discriminating between benign and malignant course in patients with small ICH, particularly 3-10 ml hematomas.


ADVANCES IN KNOWLEDGE
Radiomics can be used as a supplement to conventional medical imaging, improving clinical decision-making and facilitating personalized treatment in small ICH.