Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion

Dylan Blacquiere, Andrew M. Demchuk, Mohammed Al-Hazzaa, Anirudda Deshpande, William Petrcich, Richard I. Aviv, David Rodriguez-Luna, Carlos A. Molina, Yolanda Silva Blas, Imanuel Dzialowski, Anna Czlonkowska, Jean Martin Boulanger, Cheemun Lum, Gord Gubitz, Vasantha Padma, Jayanta Roy, Carlos S. Kase, Rohit Bhatia, Michael D. Hill, Dar Dowlatshahi

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background and Purpose-Hematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available. Methods-Baseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan. Results-Three hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50%; 28%-71%), whereas margin irregularity had the highest negative predictive value (78%; 71%-85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive. Conclusions-Fluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.

Original languageEnglish
Pages (from-to)3111-3116
Number of pages6
JournalStroke
Volume46
Issue number11
DOIs
Publication statusPublished - 01-11-2015
Externally publishedYes

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Hematoma
Tomography
Cerebral Hemorrhage
Vitamin K
National Institutes of Health (U.S.)
ROC Curve
Stroke
Morbidity
Mortality
Growth
Computed Tomography Angiography

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Blacquiere, D., Demchuk, A. M., Al-Hazzaa, M., Deshpande, A., Petrcich, W., Aviv, R. I., ... Dowlatshahi, D. (2015). Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion. Stroke, 46(11), 3111-3116. https://doi.org/10.1161/STROKEAHA.115.010566
Blacquiere, Dylan ; Demchuk, Andrew M. ; Al-Hazzaa, Mohammed ; Deshpande, Anirudda ; Petrcich, William ; Aviv, Richard I. ; Rodriguez-Luna, David ; Molina, Carlos A. ; Silva Blas, Yolanda ; Dzialowski, Imanuel ; Czlonkowska, Anna ; Boulanger, Jean Martin ; Lum, Cheemun ; Gubitz, Gord ; Padma, Vasantha ; Roy, Jayanta ; Kase, Carlos S. ; Bhatia, Rohit ; Hill, Michael D. ; Dowlatshahi, Dar. / Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion. In: Stroke. 2015 ; Vol. 46, No. 11. pp. 3111-3116.
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abstract = "Background and Purpose-Hematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available. Methods-Baseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan. Results-Three hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50{\%}; 28{\%}-71{\%}), whereas margin irregularity had the highest negative predictive value (78{\%}; 71{\%}-85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive. Conclusions-Fluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.",
author = "Dylan Blacquiere and Demchuk, {Andrew M.} and Mohammed Al-Hazzaa and Anirudda Deshpande and William Petrcich and Aviv, {Richard I.} and David Rodriguez-Luna and Molina, {Carlos A.} and {Silva Blas}, Yolanda and Imanuel Dzialowski and Anna Czlonkowska and Boulanger, {Jean Martin} and Cheemun Lum and Gord Gubitz and Vasantha Padma and Jayanta Roy and Kase, {Carlos S.} and Rohit Bhatia and Hill, {Michael D.} and Dar Dowlatshahi",
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Blacquiere, D, Demchuk, AM, Al-Hazzaa, M, Deshpande, A, Petrcich, W, Aviv, RI, Rodriguez-Luna, D, Molina, CA, Silva Blas, Y, Dzialowski, I, Czlonkowska, A, Boulanger, JM, Lum, C, Gubitz, G, Padma, V, Roy, J, Kase, CS, Bhatia, R, Hill, MD & Dowlatshahi, D 2015, 'Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion', Stroke, vol. 46, no. 11, pp. 3111-3116. https://doi.org/10.1161/STROKEAHA.115.010566

Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion. / Blacquiere, Dylan; Demchuk, Andrew M.; Al-Hazzaa, Mohammed; Deshpande, Anirudda; Petrcich, William; Aviv, Richard I.; Rodriguez-Luna, David; Molina, Carlos A.; Silva Blas, Yolanda; Dzialowski, Imanuel; Czlonkowska, Anna; Boulanger, Jean Martin; Lum, Cheemun; Gubitz, Gord; Padma, Vasantha; Roy, Jayanta; Kase, Carlos S.; Bhatia, Rohit; Hill, Michael D.; Dowlatshahi, Dar.

In: Stroke, Vol. 46, No. 11, 01.11.2015, p. 3111-3116.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intracerebral Hematoma Morphologic Appearance on Noncontrast Computed Tomography Predicts Significant Hematoma Expansion

AU - Blacquiere, Dylan

AU - Demchuk, Andrew M.

AU - Al-Hazzaa, Mohammed

AU - Deshpande, Anirudda

AU - Petrcich, William

AU - Aviv, Richard I.

AU - Rodriguez-Luna, David

AU - Molina, Carlos A.

AU - Silva Blas, Yolanda

AU - Dzialowski, Imanuel

AU - Czlonkowska, Anna

AU - Boulanger, Jean Martin

AU - Lum, Cheemun

AU - Gubitz, Gord

AU - Padma, Vasantha

AU - Roy, Jayanta

AU - Kase, Carlos S.

AU - Bhatia, Rohit

AU - Hill, Michael D.

AU - Dowlatshahi, Dar

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background and Purpose-Hematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available. Methods-Baseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan. Results-Three hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50%; 28%-71%), whereas margin irregularity had the highest negative predictive value (78%; 71%-85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive. Conclusions-Fluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.

AB - Background and Purpose-Hematoma expansion in intracerebral hemorrhage is associated with higher morbidity and mortality. The computed tomography (CT) angiographic spot sign is highly predictive of expansion, but other morphological features of intracerebral hemorrhage such as fluid levels, density heterogeneity, and margin irregularity may also predict expansion, particularly in centres where CT angiography is not readily available. Methods-Baseline noncontrast CT scans from patients enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study were assessed for the presence of fluid levels and degree of density heterogeneity and margin irregularity using previously validated scales. Presence and grade of these metrics were correlated with the presence of hematoma expansion as defined by the PREDICT study on 24-hour follow-up scan. Results-Three hundred eleven patients were included in the analysis. The presence of fluid levels and increasing heterogeneity and irregularity were associated with 24-hour hematoma expansion (P=0.021, 0.003 and 0.049, respectively) as well as increases in absolute hematoma size. Fluid levels had the highest positive predictive value (50%; 28%-71%), whereas margin irregularity had the highest negative predictive value (78%; 71%-85). Noncontrast metrics had comparable predictive values as spot sign for expansion when controlled for vitamin K, antiplatelet use, and baseline National Institutes of Health Stroke Scale, although in a combined area under the receiver-operating characteristic curve model, spot sign remained the most predictive. Conclusions-Fluid levels, density heterogeneity, and margin irregularity on noncontrast CT are associated with hematoma expansion at 24 hours. These markers may assist in prediction of outcomes in scenarios where CT angiography is not readily available and may be of future help in refining the predictive value of the CT angiography spot sign.

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