Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy.
Neuroradiology Department, Tours University Hospital, Tours, France.
Int J Stroke. 2022 Oct;17(9):1013-1020. doi: 10.1177/17474930211068662. Epub 2022 Jan 4.
Hematoma expansion (HE) is common and associated with poor outcome in intracerebral hemorrhage (ICH) with unclear symptom onset (USO).
We tested the association between non-contrast computed tomography (NCCT) markers and HE in this population.
Retrospective analysis of patients with primary spontaneous ICH admitted at five centers in the United States and Italy. Baseline NCCT was analyzed for presence of the following markers: intrahematoma hypodensities, heterogeneous density, blend sign, and irregular shape. Variables associated with HE (hematoma growth > 6 mL and/or > 33% from baseline to follow-up imaging) were explored with multivariable logistic regression.
Of 2074 patients screened, we included 646 subjects (median age = 75, 53.9% males), of whom 178 (27.6%) had HE. Hypodensities (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.79-3.98), heterogeneous density (OR = 2.16, 95% CI = 1.46-3.21), blend sign (OR = 2.28, 95% CI = 1.38-3.75) and irregular shape (OR = 1.82, 95% CI = 1.21-2.75) were independently associated with a higher risk of HE, after adjustment for confounders (ICH volume, anticoagulation, and time from last seen well (LSW) to NCCT). Hypodensities had the highest sensitivity for HE (0.69), whereas blend sign was the most specific marker (0.90). All NCCT markers were more frequent in early presenters (time from LSW to NCCT ⩽ 6 h, = 189, 29.3%), and more sensitive in this population as well (hypodensities had 0.77 sensitivity).
NCCT markers are associated with HE in ICH with USO. These findings require prospective replication and suggest that NCCT features may help the stratification of HE in future studies on USO patients.
血肿扩大（HE）在症状不明（USO）的脑出血（ICH）中很常见，并与不良预后相关。
我们在该人群中测试了非对比 CT（NCCT）标志物与 HE 之间的关联。
回顾性分析了美国和意大利 5 个中心收治的原发性自发性 ICH 患者。对基线 NCCT 进行分析，以确定以下标志物的存在：血肿内低衰减、不均匀密度、混合征和不规则形状。使用多变量逻辑回归探讨与 HE（血肿增长>6ml 和/或从基线到随访成像增加>33%）相关的变量。
在 2074 名筛选患者中，我们纳入了 646 名患者（中位年龄 75 岁，53.9%为男性），其中 178 名（27.6%）有 HE。低衰减（比值比（OR）=2.67，95%置信区间（CI）=1.79-3.98）、不均匀密度（OR=2.16，95%CI=1.46-3.21）、混合征（OR=2.28，95%CI=1.38-3.75）和不规则形状（OR=1.82，95%CI=1.21-2.75）在调整混杂因素（ICH 体积、抗凝和从最后一次状态良好（LSW）到 NCCT 的时间）后，与 HE 的高风险独立相关。低衰减对 HE 的敏感性最高（0.69），而混合征是最特异的标志物（0.90）。所有 NCCT 标志物在早期出现者中更为常见（从 LSW 到 NCCT 的时间⩽6 小时，=189，29.3%），并且在该人群中更为敏感（低衰减的敏感性为 0.77）。
ICH 中 USO 的 NCCT 标志物与 HE 相关。这些发现需要前瞻性验证，并表明 NCCT 特征可能有助于未来 USO 患者研究中 HE 的分层。
