Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Boulouis, Grégoire; Morotti, Andrea; Charidimou, Andreas; Dowlatshahi, Dar; Goldstein, Joshua N.

doi:10.1161/strokeaha.116.015062

Cited by 106 publications

(48 citation statements)

References 48 publications

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“…We hypothesized that especially the distribution of ICH density features, which is based on coagulant status, might be influenced by a therapy with oral anticoagulants. However, the distribution of all signs in our study was comparable to previous studies including patients with spontaneous ICH [13][14][15][16]18,20]. Therefore, our study suggests that outcome prediction in ICH patients under oral anticoagulation can be made using the same markers that have been proven to be useful in patients with spontaneous ICH.…”

Section: Discussionsupporting

confidence: 88%

Prognostic Value of Non-Contrast CT Markers and Spot Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage under Oral Anticoagulation

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Introduction: In patients with spontaneous intracerebral hemorrhage (ICH), several non-contrast computed tomography (NCCT) markers and the spot sign (SS) in computed tomography (CT) angiography (CTA) have been established for the prediction of hematoma growth and neurological outcome. However, the prognostic value of these markers in patients under oral anticoagulation (ORAC) is unclear. We hypothesized that outcome prediction by these imaging markers may be significantly different between patients with and without ORAC. Therefore, we aimed to investigate the predictive value of NCCT markers and SS in patients with ICH under ORAC. Methods: This is a retrospective study of the database for patients with ICH at a German tertiary stroke center. Inclusion criteria were (1) patients with ICH, (2) oral anticoagulation within the therapeutic range, and (3) NCCT and CTA performed on admission within 6 h after onset of symptoms. We defined a binary outcome: modified Rankin Scale (mRS) ≤ 3 = good outcome versus mRS > 3 = poor outcome at discharge. The predictive value of each sign was assessed in uni- and multivariable logistic regression models. Results: Of 129 patients with ICH under ORAC, 76 (58.9%) presented with hypodensities within the hematoma in admission NCCT, 64 (52.7%) presented with an irregular shape of the hematoma, 60 (46.5%) presented with a swirl sign, 49 (38.0%) presented with a black hole sign, and 46 (35.7%) presented with a heterogeneous density of the hematoma. Moreover, 44 (34.1%) patients had a satellite sign, in 20 (15.5%) patients, an island sign was detected, 18 (14.0%) patients were blend-sign positive, and 14 (10.9%) patients presented with a CTA spot sign. Inter-rater agreement was very high for all included characteristics between the two readers. Multivariable logistic regression analysis identified the presence of black hole sign (odds ratio 10.59; p < 0.001), swirl sign (odds ratio 14.06; p < 0.001), and satellite sign (odds ratio 6.38; p = 0.011) as independent predictors of poor outcome. Conclusions: The distribution and prognostic value of several NCCT markers and CTA spot sign in ICH patients under ORAC is comparable to those with spontaneous ICH, even though these parameters are partly based on coagulant status. These findings suggest that a similar approach can be used for further research regarding outcome prediction in ICH patients under ORAC and those with spontaneous ICH.

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Section: Discussionsupporting

confidence: 88%

Prognostic Value of Non-Contrast CT Markers and Spot Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage under Oral Anticoagulation

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et al. 2020

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“…NCCT biomarkers have the potential to become a readily available tool to stratify the risk of hematoma growth [26]. In a study of 1,029 ICH patients, Boulouis et al [27] proposed 4 subtypes of hypodensities that are independent predictors of hematoma expansion.…”

Section: Discussionmentioning

confidence: 99%

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Yang

Chen

et al. 2018

Cerebrovasc Dis

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Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001). Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.

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“…70 NCCT can also provide useful elements for the stratification of ICH expansion risk, such as signs reflecting heterogeneous density and markers reflecting irregular ICH shape. 71,72 Computed Tomography Angiography CTA allows rapid identification of vascular malformations underlying the hemorrhage. 73 A secondary cause of intracranial bleeding should be considered in young patients with lobar hemorrhages and lack of vascular risk factors for cerebral small vessel disease.…”

Section: Noncontrast Computed Tomographymentioning

confidence: 99%

Acute Stroke

Poli

Costa

Morotti³

2019

Semin Neurol

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Stroke remains one of the leading determinants of death and severe disability worldwide. It is a medical emergency with a narrow window for recognition and administration of outcome-modifying treatment in the emergency department. Ischemic stroke accounts for the majority of cerebrovascular events and revascularization therapies such as intravenous thrombolysis and endovascular thrombectomy are the mainstays of treatment in carefully selected patients. Intracerebral hemorrhage is less common but remains the deadliest type of stroke. Blood pressure reduction and hemostatic treatment in case of coagulopathy are the cornerstones of acute intracerebral hemorrhage treatment. Admission to dedicated stroke units is associated with improved outcome in patients suffering from acute stroke.

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Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Cited by 106 publications

References 48 publications

Prognostic Value of Non-Contrast CT Markers and Spot Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage under Oral Anticoagulation

Prognostic Value of Non-Contrast CT Markers and Spot Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage under Oral Anticoagulation

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Acute Stroke

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