SAHVER: Subarachnoid Hemorrhage Volumetric Expediting Resolution

IntroductionSubarachnoid Hemorrhage Volumetric Artificial Intelligence (SAHVAI) is a novel model that segments and quantifies Subarachnoid Hemorrhage Volume (SAHV) on non-contrast CT (NCCT) scans and generates a 3D brain volumetric map called SAHVAI-3D. It is enhanced into SAHVAI-4D when measured over time. Precise measurement of SAHV is critical to future discoveryies. For example, IRRAflow is a FDA-approved ventricular irrigation and drainage system that can expedite removal of SAH blood products. ObjectiveUtilize SAHVAI model to compare and quantify the course of SAHV resolution over time and generate SAHVAI-3D brain maps to help visualize significant SAHV resolution patterns and predict vasospasm. MethodsWe applied SAHVAI to SAH cases with mFS(3-4) using the NCCT scans among three groups. Group A included 1 SAH patient treated with the IRRAflow system. Group B included one SAH patient presented GCS 15 two days after ictus with no requirement for EVD. Group C included 10 patients who underwent regular EVD placement per standard of care. ResultsGroup A showed expedited resolution of SAHV (1.87mL/day) with an mRS of 0 on discharge and minimal vasospasm (Figures 1, 2). Group B showed 16mL increase in SAHV suspected for aneurysmal rebleeding days (5-9), and the patient later died (mRS of 6) (Figure 3). Group C showed reduction of SAHV of [~] 0.5ml /day (Figure 4). Further, the resultant 3D brain maps revealed that areas with the highest density of blood concentration were correlated with the severity and location of the vasospasm in all groups (Table 1). O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=59 SRC="FIGDIR/small/24312803v1_fig1.gif" ALT="Figure 1"> View larger version (10K): org.highwire.dtl.DTLVardef@19742forg.highwire.dtl.DTLVardef@11ac605org.highwire.dtl.DTLVardef@be8a6corg.highwire.dtl.DTLVardef@171bbe9_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1.C_FLOATNO The quantified SAHV measured via SAHVAI shows expedited resolution of SAHV (1.87mL/day) when using the active Irrigation and drainage system (the IRRAFlow). C_FIG O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=149 SRC="FIGDIR/small/24312803v1_fig2.gif" ALT="Figure 2"> View larger version (22K): org.highwire.dtl.DTLVardef@1e7e2a3org.highwire.dtl.DTLVardef@d07ae2org.highwire.dtl.DTLVardef@133a684org.highwire.dtl.DTLVardef@1f956fd_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 2.C_FLOATNO SAHVAI-3D brain maps showing the distribution of SAH before versus after the active irrigation and drainage. (A=Anterior, P= Posterior, L= Left, R=Right, S=superior, I=Inferior). C_FIG O_FIG O_LINKSMALLFIG WIDTH=196 HEIGHT=200 SRC="FIGDIR/small/24312803v1_fig3.gif" ALT="Figure 3"> View larger version (33K): org.highwire.dtl.DTLVardef@be271dorg.highwire.dtl.DTLVardef@1f9ec95org.highwire.dtl.DTLVardef@11b3993org.highwire.dtl.DTLVardef@60e37c_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 3.C_FLOATNO (a)The quantified SAHV measured via SAHVAI showing the rebleeding on day 9. (b) SAHVAI-3D brain map showing the rebleed on days (5-9) in the basal cistern, midline-frontal, and ACA distribution. (A=Anterior, P= Posterior, L= Left, R=Right, S=superior, I=Inferior). C_FIG O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=136 SRC="FIGDIR/small/24312803v1_fig4.gif" ALT="Figure 4"> View larger version (19K): org.highwire.dtl.DTLVardef@f71b87org.highwire.dtl.DTLVardef@13071e7org.highwire.dtl.DTLVardef@18610fforg.highwire.dtl.DTLVardef@c5fd1c_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 4.C_FLOATNO Plot of the Mean and Standard Deviation measured the quantitative SAH volume (SAHV) over time of the total cohort (n=10) day by day, showed reduction of SAHV of [~] 0.5ml /day C_FIG O_TBL View this table: org.highwire.dtl.DTLVardef@6c4806org.highwire.dtl.DTLVardef@ec8742org.highwire.dtl.DTLVardef@a4247borg.highwire.dtl.DTLVardef@573ffcorg.highwire.dtl.DTLVardef@29e7ba_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 1.C_FLOATNO O_TABLECAPTIONthe correlation between areas showing the highest blood concentration density with the vasospasms severity and location. C_TABLECAPTION C_TBL ConclusionSAHVAI, SAHVAI-3D and SAHVAI-4D are novel methods that reliably quantifies SAHV blood volume and changes over time including SAH blood resolution or rebleeding events. SAHVER is a model that shows how interventions such as IRRAflow can expedite SAHV resolution compared to passive EVD and non-CSF drainage groups.