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Published on: January 4, 2013
Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage
1Department of Radiology, Neuroradiology Section, University of California, San Francisco, San Francisco, CA 94143-0628, USA.
Insights
Contrast extravasation on CT scans in patients with intracerebral hemorrhage (ICH) independently predicts both increased mortality and hematoma expansion. This finding is crucial for identifying high-risk patients and guiding treatment decisions in neuroimaging.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Intracerebral hemorrhage (ICH) treatment requires reliable predictors of hematoma expansion.
- Identifying such predictors is crucial for improving patient outcomes.
Purpose of the Study:
- To determine if contrast extravasation on CT angiography (CTA) and/or contrast-enhanced CT (CECT) predicts hematoma expansion and mortality in primary ICH patients.
- To evaluate the association between imaging findings and clinical outcomes.
Main Methods:
- Retrospective review of 56 primary ICH patients who underwent CTA, CECT, and follow-up NCCT.
- Independent review of CT scans for hematoma size, growth, and contrast extravasation.
- Logistic regression analysis to assess predictors of 30-day mortality and hematoma growth.
Main Results:
- Contrast extravasation was observed in 17.9% of CTA and 23.2% of CECT scans.
- Univariate analysis linked extravasation, large hematoma size, swirl sign, and clinical scores to mortality.
- Multivariate analysis confirmed contrast extravasation as an independent predictor of both mortality (P = .017) and hematoma growth (P < .001).
Conclusions:
- Active contrast extravasation on CT is a significant independent predictor of mortality in primary ICH.
- Contrast extravasation also independently predicts hematoma growth, highlighting its importance in predicting disease progression.
Background And Purpose:
Recent studies of intracerebral hemorrhage (ICH) treatments have highlighted the need to identify reliable predictors of hematoma expansion. The goal of this study was to determine whether contrast extravasation on multisection CT angiography (CTA) and/or contrast-enhanced CT (CECT) of the brain is associated with hematoma expansion and increased mortality in patients with primary ICH.
Materials And Methods:
All patients with primary ICH who underwent CTA and CECT, as well as follow-up noncontrast CT (NCCT) before discharge/death from January 1, 2003, to September 30, 2005, were retrospectively identified. One neuroradiologist reviewed admission and follow-up NCCT for hematoma size and growth. A second neuroradiologist independently reviewed CTA and CECT for active contrast extravasation. Univariate and multivariate logistic regression analyses were performed to evaluate the significance of clinical and radiologic variables in predicting 30-day mortality, designated as the primary outcome. Hematoma growth was considered as a secondary outcome.
Results:
Of 56 patients, contrast extravasation was seen in 17.9% of patients on initial CTA and in 23.2% of patients on initial CECT following CTA. Univariate analysis showed that the presence of extravasation on CT, large initial hematoma size (>30 mL), the presence of "swirl sign" on NCCT, the Glasgow Coma Scale and ICH scores, and international normalized ratio were associated with increased mortality. On multivariate analysis, only contrast extravasation on CT (P = .017) independently predicted mortality. Contrast extravasation on CT (P < .001) was also an independent predictor of hematoma growth on multivariate analysis.
Conclusion:
Active contrast extravasation on CT in patients with primary ICH independently predicts mortality and hematoma growth.
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