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Non-contrast computed tomography features predict intraventricular hemorrhage growth.

Jawed Nawabi1,2, Frieder Schlunk3,4, Andrea Dell'Orco4

  • 1Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. jawed.nawabi@charite.de.

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|May 22, 2023
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Summary

Non-contrast CT features can predict intraventricular hemorrhage growth in intracerebral hemorrhage patients. Specific NCCT markers like irregular shape and hypodensities identify patients at higher risk for IVH expansion.

Keywords:
Cerebral hemorrhagePrognosisStrokeTomography

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Non-contrast computed tomography (NCCT) markers are established predictors of parenchymal hematoma expansion in intracerebral hemorrhage (ICH).
  • The utility of NCCT features in predicting intraventricular hemorrhage (IVH) growth remains less explored.

Purpose of the Study:

  • To investigate whether specific NCCT features can identify patients with ICH who are at risk of IVH growth.
  • To explore subtype-specific differences in the association between NCCT markers and IVH growth.

Main Methods:

  • Retrospective analysis of 731 patients with acute spontaneous ICH from four tertiary centers.
  • NCCT markers including heterogeneous density, hypodensity, black hole sign, swirl sign, blend sign, fluid level, island sign, satellite sign, and irregular shape were assessed.
  • IVH growth was defined as expansion >1 mL (eIVH) or any delayed IVH (dIVH); multivariable logistic regression was used to identify predictors.

Main Results:

  • 185 patients (25.31%) experienced IVH growth, with 130 (17.78%) showing eIVH and 55 (7.52%) showing dIVH.
  • Irregular shape was significantly associated with overall IVH growth (OR 1.68).
  • Hypodensities were linked to eIVH (OR 2.06), while irregular shape was associated with dIVH (OR 2.72). Parenchymal hematoma expansion did not mediate these associations.

Conclusions:

  • Baseline NCCT features can identify ICH patients at high risk for IVH growth.
  • Specific NCCT markers show subtype-specific associations with different types of IVH growth.
  • These findings support the use of baseline NCCT for risk stratification of IVH growth and may inform future clinical studies.