Noncontrast CT better alternative to CTA for predicting Hematoma expansion in ICH

A new study found that in intracerebral hemorrhages for identifying hematoma expansion non contrast computed tomography hypodensities are better alternatives to CTA spot signs as non-contrast CT hypodensities significantly add value and predict hematoma expansion.

The study results are published in the journal Stroke. 

Previous literature shows that in intracerebral hemorrhage non-contrast computed tomography hypodensities are a better predictor of hematoma expansion (HE) and a possible alternative to the computed tomography angiography (CTA) spot sign but there is uncertainty on the added value to available prediction models. Hence researchers conducted a multicenter study to investigate whether the inclusion of hypodensities improves the prediction of HE and compared their added value over the spot sign. 

A multicenter, retrospective analysis was carried out at 8 university hospitals on patients admitted for primary spontaneous intracerebral hemorrhage. 

Logistic regression analysis was used to explore the predictors of HE like the hematoma growth >6 mL and/or >33% from baseline to follow-up imaging. The discrimination of a simple prediction model for HE based on 4 predictors (antiplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of non-contrast computed tomography hypodensities, were compared using the receiver operating characteristic curve and De Long test for the area under the curve comparison. 

Key findings: 

• A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. 
• After adjustment for confounders in logistic regression, hypodensities were independently associated with HE. 
• The discrimination of the 4 predictors model improved with the inclusion of non-contrast computed tomography hypodensities. 
• The added value of hypodensities was statistically significant but the addition of the CTA spot sign did not provide significant discrimination improvement in the subgroup of CTA patients (n=895, 36.3%). 

Thus, non-contrast computed tomography hypodensities can be used to stratify the risk of HE with good discrimination without CTA. 

Further reading: Morotti A, Boulouis G, Nawabi J, et al. Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion [published online ahead of print, 2023 Jan 9]. Stroke. 2023;10.1161/STROKEAHA.122.041302. doi: 10.1161/STROKEAHA.122.041302