{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:23:25Z","timestamp":1787822605007,"version":"build-2784847793"},"reference-count":25,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82171311"],"award-info":[{"award-number":["82171311"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82330039"],"award-info":[{"award-number":["82330039"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471339"],"award-info":[{"award-number":["82471339"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82501542"],"award-info":[{"award-number":["82501542"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0540000"],"award-info":[{"award-number":["2024ZD0540000"]}]},{"DOI":"10.13039\/501100012247","name":"Shanghai Excellent Academic Leader Program","doi-asserted-by":"crossref","award":["21XD1400600"],"award-info":[{"award-number":["21XD1400600"]}],"id":[{"id":"10.13039\/501100012247","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Shanghai Municipal Education Commission\u2019s Project on Promoting Scientific Research Paradigm Reform and Empowering Discipline Leap","award":["2024RGZNB04"],"award-info":[{"award-number":["2024RGZNB04"]}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["2022ZZ01006"],"award-info":[{"award-number":["2022ZZ01006"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007219","name":"Shanghai Natural Science Foundation","doi-asserted-by":"crossref","award":["25ZR1402046"],"award-info":[{"award-number":["25ZR1402046"]}],"id":[{"id":"10.13039\/100007219","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Shanghai Science and Technology Commission Project","award":["23ZR1408700"],"award-info":[{"award-number":["23ZR1408700"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Stroke Vasc Neurol"],"accepted":{"date-parts":[[2025,12,27]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop an MRI habitat atlas that is robust across different haemorrhage stages for haemorrhagic brainstem cavernous malformations (BSCMs) and to integrate habitat-derived imaging biomarkers with clinical variables for precise prediction of symptomatic re-haemorrhage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort of 205 eligible patients from Huashan Main Campus (2015\u20132020) was randomly divided into a discovery set (n=147) for model development and an internal validation set (n=58). External validation was performed using a prospective temporal cohort from Huashan West Campus (2021\u20132023, n=94). Each lesion was segmented into six biologically distinct habitats via unsupervised clustering of multiparametric MRI. Habitat-derived radiomic features were combined with clinical variables into a multimodal logistic regression model, which was rigorously validated both internally and temporally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 2-year cumulative re-haemorrhage rate was 81% in high-risk lesions versus 26% in low-risk lesions. The combined habitat\u2013clinical model achieved an area under the curve (AUC) of 0.833 (95% CI 0.777 to 0.889) in the training set and 0.851 in the external validation set, significantly outperforming both imaging-only (\u2206AUC+0.07, p=0.008) and clinical-only models (\u2206AUC+0.17, p&lt;0.001). The model demonstrated excellent calibration and provided net clinical benefit across decision thresholds of 5%\u201375%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The multimodal MRI habitat atlas provides a robust and reproducible tool for individualised re-haemorrhage risk stratification in BSCMs, facilitating clinical decision-making for surveillance or intervention while reducing the likelihood of overtreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/svn-2025-004701","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T14:50:45Z","timestamp":1770216645000},"page":"473-483","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Multimodal MRI habitat atlas for personalised re-haemorrhage risk prediction in brainstem cavernous malformations"],"prefix":"10.1136","volume":"11","author":[{"given":"Haohuai","family":"Gui","sequence":"first","affiliation":[{"name":"College of Biomedical Engineering, Fudan University, Shanghai, China"},{"name":"Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuchen","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China"},{"name":"Neurosurgical Institute of Fudan University, Shanghai, China"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongze","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China"},{"name":"Neurosurgical Institute of Fudan University, Shanghai, China"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xiao","sequence":"additional","affiliation":[{"name":"College of Biomedical Engineering, Fudan University, Shanghai, 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0500-0989","authenticated-orcid":false,"given":"Hongfei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China"},{"name":"Neurosurgical Institute of Fudan University, Shanghai, China"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganglei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China"},{"name":"Neurosurgical Institute of Fudan University, Shanghai, China"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6483-2434","authenticated-orcid":false,"given":"Kai","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China"},{"name":"National Center for Neurological Disorders, Shanghai, China"},{"name":"Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China"},{"name":"Neurosurgical Institute of Fudan University, Shanghai, China"},{"name":"Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 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cerebral cavernous malformations: The role of associated developmental venous anomalies","volume":"95","author":"Chen","year":"2020","journal-title":"Neurology (ECronicon)"},{"key":"2026082702101064000_11.4.473.15","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1161\/STROKEAHA.120.031761","article-title":"Influence of Pregnancy on Hemorrhage Risk in Women With Cerebral and Spinal Cavernous Malformations","volume":"52","author":"Joseph","year":"2021","journal-title":"Stroke"},{"key":"2026082702101064000_11.4.473.16","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.515544"},{"key":"2026082702101064000_11.4.473.17","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.3390\/brainsci13091336","article-title":"Inflammatory Mechanisms in a Neurovascular Disease: Cerebral Cavernous Malformation","volume":"13","author":"Li","year":"2023","journal-title":"Brain 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