Qi Li1, Yi-Qing Shen2, Xiong-Fei Xie2, Meng-Zhou Xue3, Du Cao4, Wen-Song Yang4, Rui Li4, Lan Deng4, Miao Wei2, Fa-Jin Lv2, Guo-Feng Wu5, Zhou-Ping Tang6, Peng Xie7. 1. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. qili_md@126.com. 2. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. 3. Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China. 4. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. 5. Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China. wuguofeng3013@sina.com. 6. Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. ddjtzp@163.com. 7. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. peng_xie@yahoo.com.
Abstract
BACKGROUND: Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH). METHODS: Between July 2011 and January 2017, ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. Expansion-prone hematoma was defined as the presence of one or more of the following imaging markers: blend sign, black hole sign, or island sign. The diagnostic performance of blend sign, black hole sign, island sign, and expansion-prone hematoma in predicting hematoma expansion was assessed. Predictors of hematoma growth and poor outcome were analyzed using multivariable logistical regression analysis. RESULTS: A total of 282 patients were included in our final analysis. Of 88 patients with early hematoma growth, 69 (78.4%) had expansion-prone hematoma. Expansion-prone hematoma had a higher sensitivity and accuracy for predicting hematoma expansion and poor outcome when compared with any single imaging marker. After adjustment for potential confounders, expansion-prone hematoma independently predicted hematoma expansion (OR 28.33; 95% CI 12.95-61.98) and poor outcome (OR 5.67; 95% CI 2.82-11.40) in multivariable logistic model. CONCLUSION: Expansion-prone hematoma seems to be a better predictor than any single noncontrast CT marker for predicting hematoma expansion and poor outcome. Considering the high risk of hematoma expansion in these patients, expansion-prone hematoma may be a potential therapeutic target for anti-expansion treatment in future clinical studies.
BACKGROUND: Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH). METHODS: Between July 2011 and January 2017, ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. Expansion-prone hematoma was defined as the presence of one or more of the following imaging markers: blend sign, black hole sign, or island sign. The diagnostic performance of blend sign, black hole sign, island sign, and expansion-prone hematoma in predicting hematoma expansion was assessed. Predictors of hematoma growth and poor outcome were analyzed using multivariable logistical regression analysis. RESULTS: A total of 282 patients were included in our final analysis. Of 88 patients with early hematoma growth, 69 (78.4%) had expansion-prone hematoma. Expansion-prone hematoma had a higher sensitivity and accuracy for predicting hematoma expansion and poor outcome when compared with any single imaging marker. After adjustment for potential confounders, expansion-prone hematoma independently predicted hematoma expansion (OR 28.33; 95% CI 12.95-61.98) and poor outcome (OR 5.67; 95% CI 2.82-11.40) in multivariable logistic model. CONCLUSION: Expansion-prone hematoma seems to be a better predictor than any single noncontrast CT marker for predicting hematoma expansion and poor outcome. Considering the high risk of hematoma expansion in these patients, expansion-prone hematoma may be a potential therapeutic target for anti-expansion treatment in future clinical studies.
Authors: Andrew M Demchuk; Dar Dowlatshahi; David Rodriguez-Luna; Carlos A Molina; Yolanda Silva Blas; Imanuel Dzialowski; Adam Kobayashi; Jean-Martin Boulanger; Cheemun Lum; Gord Gubitz; Vasantha Padma; Jayanta Roy; Carlos S Kase; Jayme Kosior; Rohit Bhatia; Sarah Tymchuk; Suresh Subramaniam; David J Gladstone; Michael D Hill; Richard I Aviv Journal: Lancet Neurol Date: 2012-03-08 Impact factor: 44.182
Authors: Stephan A Mayer; Nikolai C Brun; Kamilla Begtrup; Joseph Broderick; Stephen Davis; Michael N Diringer; Brett E Skolnick; Thorsten Steiner Journal: N Engl J Med Date: 2005-02-24 Impact factor: 91.245
Authors: J N Goldstein; L E Fazen; R Snider; K Schwab; S M Greenberg; E E Smith; M H Lev; J Rosand Journal: Neurology Date: 2007-03-20 Impact factor: 9.910
Authors: Ryan Wada; Richard I Aviv; Allan J Fox; Demetrios J Sahlas; David J Gladstone; George Tomlinson; Sean P Symons Journal: Stroke Date: 2007-02-22 Impact factor: 7.914
Authors: Charlotte Jj van Asch; Merel Ja Luitse; Gabriël Je Rinkel; Ingeborg van der Tweel; Ale Algra; Catharina Jm Klijn Journal: Lancet Neurol Date: 2010-01-05 Impact factor: 44.182
Authors: Candice Delcourt; Yining Huang; Hisatomi Arima; John Chalmers; Stephen M Davis; Emma L Heeley; Jiguang Wang; Mark W Parsons; Guorong Liu; Craig S Anderson Journal: Neurology Date: 2012-06-27 Impact factor: 9.910