title: Discrimination of Tumorous Intracerebral Hemorrhage from Benign Causes Using CT Densitometry.
abstract: OBJECTIVE
  Differentiation of tumorous intracerebral hemorrhage from benign etiology is critical in initial treatment plan and prognosis. Our aim was to investigate the diagnostic value of CT densitometry to discriminate tumorous and nontumorous causes of acute intracerebral hemorrhage.
  
  
  METHODS
  This retrospective study included 110 patients with acute intracerebral hemorrhage classified into 5 groups: primary intracerebral hemorrhage without (group 1) or with antithrombotics (group 2) and secondary intracerebral hemorrhage with vascular malformation (group 3), brain metastases (group 4), or primary brain tumors (group 5). The 5 groups were dichotomized into tumorous (groups 4 and 5) and nontumorous intracerebral hemorrhage (groups 1-3). Histogram parameters of hematoma attenuation on nonenhanced CT were compared among the groups and between tumorous and nontumorous intracerebral hemorrhages. With receiver operating characteristic analysis, optimal cutoffs and area under the curve were calculated for discriminating tumorous and nontumorous intracerebral hemorrhages.
  
  
  RESULTS
  Histogram analysis of acute intracerebral hemorrhage attenuation showed that group 1 had higher mean, 5th, 25th, 50th, and 75th percentile values than groups 4 and 5 and higher minimum and 5th percentile values than group 2. Group 3 had higher 5th percentile values than groups 4 and 5. After dichotomization, all histogram parameters except maximum and kurtosis were different between tumorous and nontumorous intracerebral hemorrhages, with tumors having lower cumulative histogram parameters and positive skewness. In receiver operating characteristic analysis, 5th and 25th percentile values showed the highest diagnostic performance for discriminating tumorous and nontumorous intracerebral hemorrhages, with 0.81 area under the curve, cutoffs of 34 HU and 44 HU, sensitivities of 65.6% and 70.0%, and specificities of 85.0% and 80.0%, respectively.
  
  
  CONCLUSIONS
  CT densitometry of intracerebral hemorrhage on nonenhanced CT might be useful for discriminating tumorous and nontumorous causes of acute intracerebral hemorrhage.
authors: From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., S.-K.L.).
authors: Y S
authors: http://orcid.org/0000-0002-6034-9912
authors: YS
authors: Choi
authors: Department of Ophthalmology, Institute of Vision Research (T.H.R.), College of Medicine, Yonsei University, Seoul, Korea.
authors: T H
authors: TH
authors: Rim
authors: From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., S.-K.L.).
authors: S S
authors: SS
authors: Ahn
authors: From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., S.-K.L.) SLEE@yuhs.ac.
authors: S-K
authors: SK
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D003720:Densitometry; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
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