Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Morotti, Andrea; Arba, Francesco; Boulouis, Grégoire; Charidimou, Andreas

doi:10.1212/wnl.0000000000010660

Cited by 76 publications

(66 citation statements)

References 49 publications

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“…9 10 Independent imaging predictors include the blend sign and the black hole sign. 11 Furthermore, the spot sign on CT angiography (CTA) is a validated biomarker for active intracerebral bleeding and is associated with clinical deterioration and poor outcome. [12][13][14][15] We, therefore, designed a randomised controlled trial to investigate whether tranexamic acid could reduce the risk of haematoma expansion in ICH patients with either the spot, black hole or blend sign.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial

Liu

Nie

et al. 2021

Stroke Vasc Neurol

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BackgroundStudies show tranexamic acid can reduce the risk of death and early neurological deterioration after intracranial haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in intracerebral haemorrhage patients susceptible to haemorrhage expansion.MethodsWe did a prospective, double-blind, randomised, placebo-controlled trial at 10 stroke centres in China. Acute supratentorial intracerebral haemorrhage patients were eligible if they had indication of haemorrhage expansion on admission imaging (eg, spot sign, black hole sign or blend sign), and were treatable within 8 hours of symptom onset. Patients were randomly assigned (1:1) to receive either tranexamic acid or a matching placebo. The primary outcome was intracerebral haematoma growth (>33% relative or >6 mL absolute) at 24 hours. Clinical outcomes were assessed at 90 days.ResultsOf the 171 included patients, 124 (72.5%) were male, and the mean age was 55.9±11.6 years. 89 patients received tranexamic acid and 82 received placebo. The primary outcome did not differ significantly between the groups: 36 (40.4%) patients in the tranexamic acid group and 34 (41.5%) patients in the placebo group had intracranial haemorrhage growth (OR 0.96, 95% CI 0.52 to 1.77, p=0.89). The proportion of death was lower in the tranexamic acid treatment group than placebo group (8.1% vs 10.0%), but there were no significant differences in secondary outcomes including absolute intracranial haemorrhage growth, death and dependency.ConclusionsAmong patients susceptible to haemorrhage expansion treated within 8 hours of stroke onset, tranexamic acid did not significantly prevent intracerebral haemorrhage growth. Larger studies are needed to assess safety and efficacy of tranexamic acid in intracerebral haemorrhage patients.

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Section: Introductionmentioning

confidence: 99%

Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial

Liu

Nie

et al. 2021

Stroke Vasc Neurol

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“…Multiple NCCT shape and density features have been linked with poor clinical evolution. [38,39,61] Recently a meta-analysis including more than 10,000 patients confirmed the prognostic significance of several NCCT markers, such as black hole sign, swirl sign, heterogeneous density, blend sign, hypodensities, irregular shape, and island sign [36]. When CTA images are available, the CTA spot sign is also independently associated with higher risk of death and unfavorable functional outcome [62].…”

Section: Imaging To Predict Outcomementioning

confidence: 96%

“…Multiple non-contrast CT (NCCT) ICH features have emerged as reliable alternative to the CTA spot sign [36] (Figure 2). NCCT markers can be categorized into ICH shape features and ICH density features and consensus criteria for their detection and interpretation have been recently proposed to harmonize terminology and use in future studies [37].…”

Section: Imaging To Predict Ich Expansionmentioning

confidence: 99%

Neuroimaging of Acute Intracerebral Hemorrhage

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Psychogios

Boulouis

et al. 2021

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Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.

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“…6 In theory, haemostatic therapy is more suitable for patients with high-risk for ICH growth, such as patients with early CT signs of haematoma expansion. 7 For this reason, high-risk haematoma growth patients with ICH with image markers, such as the spot sign, 8 9 black hole sign 10 and blend sign 11 on CT scan were identified as candidates for haemostatic therapy studied in several randomised trials. 6 12-14 With the recent completion of Tranexamic Acid for Acute ICH Growth prEdicted by Spot Sign (TRAIGE) trial 12 and the results of other trials using haemostatic agents, a possible consistent trend for reducing haematoma expansion was seen.…”

Section: Introductionmentioning

confidence: 99%

Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials

Nie

Liu

et al. 2021

Stroke Vasc Neurol

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Background and purposeCurrent randomised controlled trials (RCTs) showed an uncertain benefit of haemostatic therapy on preventing haematoma expansion and improving the outcome in patients with intracerebral haemorrhage (ICH). This meta-analysis aims to systematically evaluate the effect of haemostatic agents on the prevention of haemorrhage growth in patients with high-risk spontaneous ICH predicted by CT signs in RCTs.MethodsA comprehensive search of PubMed, EMBASE and Cochrane library from 1 January 2005 to 30 June 2021 was conducted. RCTs that compared haemostatic agents with placebo for the treatment of spontaneous patients with ICH with high-risk haemorrhage growth were included. The primary endpoint was haematoma expansion at 24 hours. Other major endpoints of interest included 90-day functional outcome and mortality.ResultsThe meta-analysis included four RCTs that randomised 2666 patients with ICH with high-risk haemorrhage growth. Haemostatic therapy reduced the rate of haematoma expansion at a marginally statistically significant level when compared with placebo (OR 0.84; 95% CI 0.70 to 1.00; p=0.051). Subgroup analysis for patients with black hole sign on CT revealed a significant reduction of haematoma expansion with haemostatic therapy (OR 0.61; 95% CI 0.39 to 0.94; p=0.03). However, both the primary analysis and subgroup analyses showed that haemostatic therapy could not reduce the rate of poor functional outcome (modified Rankin Scale >3) or death.ConclusionsHaemostatic therapy showed a marginally significant benefit in reducing early haematoma expansion in patients with high-risk spontaneous ICH predicted by markers on CT scan. However, no significant improvement in functional outcome or reduction of mortality was observed.

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Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Cited by 76 publications

References 49 publications

Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial

Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial

Neuroimaging of Acute Intracerebral Hemorrhage

Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials

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