Quantitative CT Densitometry for Predicting Intracerebral Hemorrhage Growth

Barras, Christen; Tress, Brian M.; Christensen, Søren; Collins, Marnie; Desmond, Patricia; Skolnick, Brett E.; Mayer, Stephan A.; Davis, Stephen M.

doi:10.3174/ajnr.a3375

Cited by 50 publications

(37 citation statements)

References 32 publications

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“…In a recent study, Barras et al 19 developed a promising computer-assisted quantitative CT densitometry for assessment of hematoma heterogeneity. The technique is based on several derived parameters of CT densitometry that includes mean attenuation, square root of variance, coefficient of variation, skewness, and kurtosis.…”

Section: Discussionmentioning

confidence: 99%

Black Hole Sign

Zhang

Xiong

et al. 2016

Stroke

226

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Background and Purpose-Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage. Methods-Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth. Results-A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of back hole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model. Conclusions-The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Black Hole Sign

Zhang

Xiong

et al. 2016

Stroke

226

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“…Although the precise mechanism of hematoma expansion is unclear, it may be attributable to persistent bleeding or re-bleeding from the initial blood vessel rupture or new foci of bleeding at the periphery of the lesion, often attributed to ischemia, poor venous flow, and local coagulopathy [80,81]. Large hematoma and a heterogeneous pattern can also be predictive of potential expansion [82,83]. The higher volume of hematoma expansion is associated with worse outcomes [79].…”

Section: Hematoma Expansionmentioning

confidence: 99%

Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

et al. 2018

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Background: Intracerebral hemorrhage (ICH) represents 10-15% of all stroke cases in the US annually. Fewer than 40% of these patients ever reach long-term functional independence, and mortality rate is roughly 40% at 1 month. Due to the high morbidity and mortality rates after ICH, early detection of high-risk patients would be beneficial in directing the management course and goals of care. This review aims to discuss relevant clinical and radiographic characteristics that can serve as predictors of poor prognosis and examine their efficacy in predicting patient outcomes after ICH. Summary: A literature review was conducted on various clinical and radiographic factors. They were examined for their predictive value in relation to ICH outcome. Studies that focused on each of these factors were included, and their results analyzed for trends with regard to incidence, patient outcome, and mortality rate. Key Message: In this review, we examined clinical and radiographic characteristics that have been found to be significantly associated to a varying degree with poor outcome. Clinical and radiographic predictors of poor patient outcome are invaluable when it comes to identifying high-risk patients and triaging accordingly as well as guiding decision-making.

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“…Hematoma heterogeneity may partially reflect the presence of active extravasation within the hematoma in which uncoagulated blood appears iso-or hypodense relative to the brain parenchyma on CT [11]. Quantitative hematoma heterogeneity analysis using CT densitometry (CTD) is theoretically more robust, reproducible, and less prone to interpretation bias compared to qualitative techniques [5,6]. CTD may also facilitate rapid and reliable expansion prediction in the acute setting using semi-automated techniques [12].…”

Section: Introductionmentioning

confidence: 98%

“…Prevention of expansion is an attractive therapeutic target however improved means for expansion prediction are needed to guide potential acute interventions [3,4]. Previous studies have identified heterogeneity or low-attenuation within a hematoma on hyperacute NCCT, coined the 'swirl sign' , to be predictive of expansion and poor outcome [5][6][7][8][9][10][11]. Hematoma heterogeneity may partially reflect the presence of active extravasation within the hematoma in which uncoagulated blood appears iso-or hypodense relative to the brain parenchyma on CT [11].…”

Section: Introductionmentioning

confidence: 99%

Swirls and spots: relationship between qualitative and quantitative hematoma heterogeneity, hematoma expansion, and the spot sign

Connor

Huynh

Demchuk

et al. 2015

Neurovascular Imaging

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Background: Acute intracerebral hemorrhage (ICH) heterogeneity on NCCT, characterized by qualitative and quantitative methods, is predictive of hematoma expansion and mortality however association with the spot sign is not well-described. We sought to validate and determine the association between qualitative and quantitative hematoma heterogeneity with expansion and the spot sign, respectively. Methods: We retrospectively studied 71 ICH patients presenting <24 h post-ictus with baseline NCCT, CTA and 24-hour follow-up CT available. Baseline NCCT was assessed qualitatively for presence of swirl sign or hematoma heterogeneity by two independent readers blinded to CTA findings and quantitatively using CT densitometry (CTD). Associations with 24-hour hematoma expansion ≥6 ml or ≥33 % and spot sign were assessed using logistic regression and diagnostic performance was assessed. Association between qualitative and quantitative densitometry parameters was also examined. Results: Swirl sign and quantitative CTD standard deviation were independently associated with expansion on multivariable analysis (p = 0.037 and p = 0.032, respectively). Swirl sign and hematoma heterogeneity were predictive of CTA spot sign (p = 0.020 and p = 0.035, respectively) while CTD standard deviation demonstrated only trend univariate association. CTD parameters were not significantly associated with swirl sign while only CTD skewness was associated with hematoma heterogeneity. Agreement for swirl sign and hematoma heterogeneity identification was nearly perfect (κ = 0.81) and substantial (κ = 0.79) respectively. Conclusion: NCCT qualitative parameters predict hematoma expansion and CTA spot sign presence. Quantitative markers independently predict hematoma expansion but not CTA spot sign presence.

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Quantitative CT Densitometry for Predicting Intracerebral Hemorrhage Growth

Abstract: BACKGROUND AND PURPOSE:Intracerebral hemorrhage growth independently predicts disability and death. We hypothesized that noncontrast quantitative CT densitometry reflects active bleeding and improves predictive models of growth.

Cited by 50 publications

References 32 publications

Black Hole Sign

Black Hole Sign

Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

Swirls and spots: relationship between qualitative and quantitative hematoma heterogeneity, hematoma expansion, and the spot sign

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