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NCCT Markers of Intracerebral Hemorrhage Expansion Using Revised Criteria: An External Validation of Their Predictive
C Ducroux1,2,3,4, A Nehme5,2, B Rioux5,2,6
1From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine cducroux@toh.ca.
Insights
No single non-contrast computed tomography (NCCT) marker accurately predicts hematoma expansion in intracerebral hemorrhage patients. The black hole sign showed the strongest association, but further research is needed for improved prediction.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Hematoma expansion is a key determinant of outcomes in intracerebral hemorrhage (ICH).
- Non-contrast computed tomography (NCCT) based markers are used to predict hematoma expansion.
- Existing NCCT markers have limitations in accurately predicting expansion.
Purpose of the Study:
- To evaluate the predictive accuracy of nine expansion markers on NCCT.
- To identify which NCCT markers are independently associated with revised hematoma expansion.
Main Methods:
- Retrospective analysis of 124 ICH patients admitted within 24 hours of last known well.
- Primary outcome: revised hematoma expansion (≥6 mL or ≥33% ICH volume increase, ≥1 mL IVH increase, or de novo IVH).
- Assessed sensitivity, specificity, and likelihood ratios of 9 expansion markers; logistic regression identified associations.
Main Results:
- 51% of patients experienced revised hematoma expansion.
- Five markers (black hole, hypodensity, blend, satellite, Barras shape) were significantly associated in univariable analysis.
- Only the black hole marker remained independently associated with revised hematoma expansion in multivariable analysis (aOR=5.62).
Conclusions:
- No single NCCT expansion marker demonstrated both high sensitivity and specificity for predicting revised hematoma expansion.
- The black hole sign is the most promising NCCT marker but requires further validation.
- Improved image-based analysis is necessary to overcome limitations of current NCCT-based markers.
Background And Purpose:
Several NCCT expansion markers have been proposed to improve the prediction of hematoma expansion. We retrospectively evaluated the predictive accuracy of 9 expansion markers.
Materials And Methods:
Patients admitted for intracerebral hemorrhage within 24 hours of last seen well were retrospectively included from April 2016 to April 2020. The primary outcome was revised hematoma expansion, defined as any of a ≥6-mL or ≥33% increase in intracerebral hemorrhage volume, a ≥ 1-mL increase in intraventricular hemorrhage volume, or de novo intraventricular hemorrhage. We assessed the predictive accuracy of expansion markers and determined their association with revised hematoma expansion.
Results:
We included 124 patients, of whom 51 (41%) developed revised hematoma expansion. The sensitivity of each marker for the prediction of revised hematoma expansion ranged from 4% to 78%; the specificity, 37%-97%; the positive likelihood ratio, 0.41-7.16; and the negative likelihood ratio, 0.49-1.06. By means of univariable logistic regressions, 5 markers were significantly associated with revised hematoma expansion: black hole (OR = 8.66; 95% CI, 2.15-58.14; P = .007), hypodensity (OR = 3.18; 95% CI, 1.49-6.93; P = .003), blend (OR = 2.90; 95% CI, 1.08-8.38; P = .04), satellite (OR = 2.84; 95% CI, 1.29-6.61; P = .01), and Barras shape (OR = 2.41, 95% CI; 1.17-5.10; P = .02). In multivariable models, only the black hole marker remained independently associated with revised hematoma expansion (adjusted OR = 5.62; 95% CI, 1.23-40.23; P = .03).
Conclusions:
No single NCCT expansion marker had both high sensitivity and specificity for the prediction of revised hematoma expansion. Improved image-based analysis is needed to tackle limitations associated with current NCCT-based expansion markers.
