Noncontrast computed tomography markers of outcome in intracerebral hemorrhage patients

Objectives: The characterization of markers capable of predicting clinically significant hematoma growth (HG) in patients with intracerebral hemorrhage (ICH) may be useful for the selection of patients for clinical trials. The use of several noncontrast computed tomography (NCCT) markers has been suggested to stratify the risk of HG. The aim of this study was to analyze HG prediction using different NCCT markers in patients with spontaneous ICH.

Methods: Single-hospital retrospective study of patients with spontaneous ICH, who underwent initial NCCT <24 hours after symptom onset. Clinical characteristics were collected and two independent observers analyzed hemorrhage characteristics, volumes and 8 NCCT markers. HG was defined as a growth of ≥33% or ≥6mL in follow-up CT and 30-day survival was collected.

Results: 328 patients were included. The most frequent NCCT marker was ‘any hypodensity’ (68.0%) and the less frequent was the blend sign (11.6%). HG occurred in 22.1% of patients and the only independent predictors for HG were ‘any hypodensity’ (OR=3.32, 95%CI=1.18–9.34, p=0.023) and the swirl sign (OR=3.98, 95%CI=1.41–11.21, p=0.009). Although all NCCT markers were more frequent in patients who died within 30 days, the only independent predictors were ‘irregular margins’ (OR=4.54, 95%CI=1.63–12.66, p=0.004) and the satellite sign (OR=2.49, 95%CI=1.07–5.75, p=0.034). NCCT markers with greater sensitivity for HG were ‘any hypodensity’ and the swirl sign, although with poor positive predictive values and poor areas under the curve.

Conclusion: Even though some NCCT markers are independent predictors of HG and 30-day survival, they have suboptimal diagnostic test performances for such outcomes.

Abbreviation: OR: odds ratio; 95%CI: 95% confidence interval