European Radiology

, Volume 28, Issue 10, pp 4389–4396 | Cite as

Quantitative parameters of CT texture analysis as potential markers for early prediction of spontaneous intracranial hemorrhage enlargement

  • Qijun Shen
  • Yanna Shan
  • Zhengyu Hu
  • Wenhui Chen
  • Bing Yang
  • Jing Han
  • Yanfang Huang
  • Wen Xu
  • Zhan FengEmail author
Computed Tomography



To objectively quantify intracranial hematoma (ICH) enlargement by analysing the image texture of head CT scans and to provide objective and quantitative imaging parameters for predicting early hematoma enlargement.


We retrospectively studied 108 ICH patients with baseline non-contrast computed tomography (NCCT) and 24-h follow-up CT available. Image data were assessed by a chief radiologist and a resident radiologist. Consistency analysis between observers was tested. The patients were divided into training set (75%) and validation set (25%) by stratified sampling. Patients in the training set were dichotomized according to 24-h hematoma expansion ≥ 33%. Using the Laplacian of Gaussian bandpass filter, we chose different anatomical spatial domains ranging from fine texture to coarse texture to obtain a series of derived parameters (mean grayscale intensity, variance, uniformity) in order to quantify and evaluate all data. The parameters were externally validated on validation set.


Significant differences were found between the two groups of patients within variance at V1.0 and in uniformity at U1.0, U1.8 and U2.5. The intraclass correlation coefficients for the texture parameters were between 0.67 and 0.99. The area under the ROC curve between the two groups of ICH cases was between 0.77 and 0.92. The accuracy of validation set by CTTA was 0.59–0.85.


NCCT texture analysis can objectively quantify the heterogeneity of ICH and independently predict early hematoma enlargement.

Key Points

• Heterogeneity is helpful in predicting ICH enlargement.

• CTTA could play an important role in predicting early ICH enlargement.

• After filtering, fine texture had the best diagnostic performance.

• The histogram-based uniformity parameters can independently predict ICH enlargement.

• CTTA is more objective, more comprehensive, more independently operable, than previous methods.


Cerebral hemorrhage/diagnostic imaging Stroke Disease progression Tomography X-ray computed Algorithms 



Activated partial prothrombin time


Area under the ROC curve


Baseline volume


CT angiography


Computed tomography texture analysis


Field of view


Glasgow coma scale


Intraclass correlation coefficient


Intracranial hematoma


Laplacian of Gaussian


Mean gray-level intensity


Matrix Laboratory


Non-contrast computed tomography


National Institutes of Health stroke scale


Receiver operating characteristic curve


Region of interest


Time to scan







This study has received funding by the Department of Health of Zhejiang Province, China (No. 2017KY051).

This study has received funding by the Department of Health of Zhejiang Province, China (No. 2018KY582).

This study also has received funding by Hangzhou science and Technology Commission, China (No. 164519).

Compliance with ethical standards


The scientific guarantor of this publication is Zhan Feng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because of the retrospective nature of the study.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyHangzhou First People’s HospitalHangzhouChina
  2. 2.Department of RadiologySecond People’s Hospital of Yuhang DistrictHangzhouChina
  3. 3.Department of Radiology, First Affiliated Hospital of College of Medical ScienceZhejiang UniversityHangzhouChina

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