Total intracranial volume as a covariate for predicting prognosis in patients with primary intracerebral hemorrhage.

OBJECTIVES

The initial hematoma volume is reliable and stable imaging predictor for the outcome of patients with intracerebral hemorrhage, and the total intracranial volume varies between patients. However, the role of total intracranial volume in predicting the prognosis of spontaneous intracerebral hemorrhage has not been previously addressed.

METHODS

782 patients with spontaneous intracerebral hemorrhage were selected in this retrospective cohort at the Neurosurgery Emergency Unit of The First Affiliated Hospital of Harbin Medical University. Due to missing CT images, initial CT exceeding 24 h, traumatic cerebral hemorrhage, and aneurysm, 145 patients were excluded and the remaining 637 patients were included in our analysis. Functional outcome was assessed using the modified Rankin Scale(mRS) and mortality at 3-months after spontaneous intracerebral hemorrhage. CT image datasets were calculated by 3D-Slicer. The initial hematoma volume was normalized to the total intracranial volume to evaluate poor functional outcomes (mRS, 4-6) and mortality.

RESULTS

The results demonstrated that normalized initial hematoma volume can be used as an indicator of poor functional outcome (mRS, 4-6) (AUC=0.753, 95%-CI:0.710-0.795, p < 0.001), mortality (AUC=0.808, 95%-CI:0.754-0.862, p < 0.001) and hematoma expansion (AUC=0.690, 95%-CI:0.613-0.767, p < 0.001). Meanwhile, the initial hematoma volume in predicting poor functional outcome (AUC=0.749, 95%-CI:0.707-0.792, p < 0.001), mortality (AUC=0.816, 95%-CI: 0.763-0.870, p < 0.001) and hematoma expansion (AUC=0.704, 95%-CI: 0.626-0.782, p < 0.001) was similar to the normalized initial hematoma volume.

CONCLUSIONS

The normalized initial hematoma volume has no apparent benefit in predicting the prognosis of patients with cerebral hemorrhage compared with initial hematoma volume.