Mutimer Chloe A, Sharma Sameer, Zhao Henry, Meretoja Atte, Churilov Leonid, Wu Teddy Y, Kleinig Timothy J, Choi Philip M, Cheung Andrew, Jeng Jiann-Shing, Ma Henry, Mai Duy Ton, Nguyen Huy-Thang, Sharma Gagan, Campbell Bruce Cv, Donnan Geoffrey A, Davis Stephen M, Yassi Nawaf
Department of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.
Eur Stroke J. 2025 Jul 12:23969873251355938. doi: 10.1177/23969873251355938.
The predictive value of CT markers of intracerebral haemorrhage (ICH) expansion is time-dependent, but data in the ultra-early period (<2 h from onset) are limited. We aimed to describe the frequency of these CT markers, their association with haematoma volume, haematoma expansion (HE) and functional outcome at 90-days. We also investigated the effect of tranexamic acid on HE in the presence of these markers.
We performed a pooled analysis of individual patient data from the STOP-AUST and STOP-MSU placebo-controlled randomised trials of tranexamic acid, including ICH patients scanned within 2 h of symptom onset. Logistic regression was used to assess the association between CT markers and HE or 90-days functional outcomes (poor outcome defined as mRS3-6).
Among 246 patients, the swirl sign (74.3%) was the most frequent CT marker and the blend sign least frequent (7.3%). All markers were associated with increased baseline haematoma volume, and excluding the black hole sign, all were more common in patients with 24-h HE. The blend and spot signs were associated with 24-h HE and heterogenous density, swirl sign, hypodensity and island sign were associated with poor 90-day function outcomes in univariate logistic regression. However, the area under the receiver-operating-characteristic curve was similar for all markers and indicated low discriminative ability (Chi-squared test = 0.81). A potential benefit of tranexamic acid in HE reduction was observed in patients with the spot sign (interaction = 0.01)Conclusions:The discriminative utility of CT markers of HE in the early timeframe appears insufficient. There may be an effect of tranexamic acid in spot sign positive patients <2 h from onset.
脑出血（ICH）扩展的CT标志物的预测价值具有时间依赖性，但超早期（发病后<2小时）的数据有限。我们旨在描述这些CT标志物的出现频率、它们与血肿体积、血肿扩展（HE）以及90天时功能结局的关联。我们还研究了在存在这些标志物的情况下氨甲环酸对HE的影响。
我们对来自氨甲环酸的STOP - AUST和STOP - MSU安慰剂对照随机试验的个体患者数据进行了汇总分析，包括症状发作后2小时内进行扫描的ICH患者。采用逻辑回归评估CT标志物与HE或90天功能结局（不良结局定义为mRS 3 - 6）之间的关联。
在246例患者中，漩涡征（74.3%）是最常见的CT标志物，混合征最不常见（7.3%）。所有标志物均与基线血肿体积增加相关，除黑洞征外，所有标志物在24小时内发生HE的患者中更常见。在单变量逻辑回归中，混合征和斑点征与24小时HE相关，漩涡征、低密度和岛状征与90天功能不良结局相关。然而，所有标志物的受试者工作特征曲线下面积相似，表明鉴别能力较低（卡方检验=0.81）。在有斑点征的患者中观察到氨甲环酸在减少HE方面有潜在益处（交互作用=0.0）
早期时间范围内HE的CT标志物的鉴别效用似乎不足。在发病后<2小时且有斑点征的患者中，氨甲环酸可能有作用。
