Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion

作者全名："Morotti, Andrea; Boulouis, Gregoire; Nawabi, Jawed; Li, Qi; Charidimou, Andreas; Pasi, Marco; Schlunk, Frieder; Shoamanesh, Ashkan; Katsanos, Aristeidis H.; Mazzacane, Federico; Busto, Giorgio; Arba, Francesco; Brancaleoni, Laura; Giacomozzi, Sebastiano; Simonetti, Luigi; Warren, Andrew D.; Laudisi, Michele; Cavallini, Anna; Gurol, Edip M.; Viswanathan, Anand; Zini, Andrea; Casetta, Ilaria; Fainardi, Enrico; Greenberg, Steven M.; Padovani, Alessandro; Rosand, Jonathan; Goldstein, Joshua N."

作者地址："[Morotti, Andrea] ASST Spedali Civili, Dept Neurol Sci & Vis, Neurol Unit, Ple Spedali Civili 1, I-25100 Brescia, Italy; [Boulouis, Gregoire] Univ Hosp Tours, Neuroradiol Dept, Tours 09, France; [Nawabi, Jawed] Charite Univ Med Berlin, Dept Radiol CCM, Campus Mitte, Berlin, Germany; [Nawabi, Jawed; Schlunk, Frieder] Humboldt Univ, Berlin, Germany; [Nawabi, Jawed; Schlunk, Frieder] Free Univ Berlin, Berlin, Germany; [Nawabi, Jawed] Berlin Inst Hlth, Berlin, Germany; [Nawabi, Jawed; Schlunk, Frieder] Berlin Inst Hlth BIH, BIH Biomed Innovat Acad, Berlin, Germany; [Li, Qi] Anhui Med Univ, Dept Neurol, Affiliated Hosp 2, Hefei, Peoples R China; [Li, Qi] Chongqing Med Univ, Dept Neurol, Affiliated Hosp 1, Chongqing, Peoples R China; [Charidimou, Andreas] Boston Univ, Sch Med, Dept Neurol, Boston, MA 02118 USA; [Charidimou, Andreas; Warren, Andrew D.; Gurol, Edip M.; Viswanathan, Anand; Greenberg, Steven M.; Rosand, Jonathan; Goldstein, Joshua N.] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, JP Kistler Stroke Res Ctr, Boston, MA 02115 USA; [Pasi, Marco] Univ Hosp Tours, Neurol Dept, Tours 09, France; [Schlunk, Frieder] Charite Univ Med Berlin, Dept Neuroradiol, Berlin, Germany; [Shoamanesh, Ashkan; Katsanos, Aristeidis H.] McMaster Univ, Div Neurol, Hamilton, ON, Canada; [Shoamanesh, Ashkan; Katsanos, Aristeidis H.] Populat Hlth Res Inst, Hamilton, ON, Canada; [Mazzacane, Federico; Cavallini, Anna] IRCCS Fdn Mondino, UC Malattie Cerebrovascolari & Stroke Unit, Pavia, Italy; [Boulouis, Gregoire; Fainardi, Enrico] Univ Firenze, Dept Biomed Expt & Clin, Neuroradiol, AOU Careggi, Florence, Italy; [Arba, Francesco] AOU Careggi, Stroke Unit, Florence, Italy; [Brancaleoni, Laura; Giacomozzi, Sebastiano; Zini, Andrea] Osped Maggiore Bologna, IRCCS Ist Sci Neurol Bologna, UOC Neurol & Rete Stroke Metropolitana, Bologna, Italy; [Simonetti, Luigi] Osped Maggiore Bologna, IRCCS Ist Sci Neurol Bologna, Unita Neuroradiol, Bologna, Italy; [Laudisi, Michele; Casetta, Ilaria] Univ Ferrara, Osped Univ S Anna, Dipartimento Sci Biomed & Chirurg Specialist, Clin Neurol, Ferrara, Italy; [Padovani, Alessandro] Univ Brescia, Dept Clin & Expt Sci, Neurol Unit, Brescia, Italy; [Rosand, Jonathan] Harvard Med Sch, Massachusetts Gen Hosp, Div Neurocrit Care & Emergency Neurol, Dept Neurol, Boston, MA 02115 USA; [Rosand, Jonathan; Goldstein, Joshua N.] Massachusetts Gen Hosp, Henry & Allison McCance Ctr Brain Hlth, Boston, MA 02114 USA; [Goldstein, Joshua N.] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA"

通信作者："Morotti, A (通讯作者)，ASST Spedali Civili, Dept Neurol Sci & Vis, Neurol Unit, Ple Spedali Civili 1, I-25100 Brescia, Italy."

来源：STROKE

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000918148000042

JCR分区：Q1

影响因子：8.3

年份：2023

卷号：54

期号：2

开始页：567

结束页：574

文献类型：Article

关键词：computed tomography; hematoma expansion; intracerebral hemorrhage; ROC curve; stroke

摘要："Background:Noncontrast computed tomography hypodensities are a validated predictor of hematoma expansion (HE) in intracerebral hemorrhage and a possible alternative to the computed tomography angiography (CTA) spot sign but their added value to available prediction models remains unclear. We investigated whether the inclusion of hypodensities improves prediction of HE and compared their added value over the spot sign. Methods:Retrospective analysis of patients admitted for primary spontaneous intracerebral hemorrhage at the following 8 university hospitals in Boston, US (1994-2015, prospective), Hamilton, Canada (2010-2016, retrospective), Berlin, Germany (2014-2019, retrospective), Chongqing, China (2011-2015, retrospective), Pavia, Italy (2017-2019, prospective), Ferrara, Italy (2010-2019, retrospective), Brescia, Italy (2020-2021, retrospective), and Bologna, Italy (2015-2019, retrospective). Predictors of HE (hematoma growth >6 mL and/or >33% from baseline to follow-up imaging) were explored with logistic regression. We compared the discrimination of a simple prediction model for HE based on 4 predictors (antitplatelet and anticoagulant treatment, baseline intracerebral hemorrhage volume, and onset-to-imaging time) before and after the inclusion of noncontrast computed tomography hypodensities, using receiver operating characteristic curve and De Long test for area under the curve comparison. Results:A total of 2465 subjects were included, of whom 664 (26.9%) had HE and 1085 (44.0%) had hypodensities. Hypodensities were independently associated with HE after adjustment for confounders in logistic regression (odds ratio, 3.11 [95% CI, 2.55-3.80]; P<0.001). The inclusion of noncontrast computed tomography hypodensities improved the discrimination of the 4 predictors model (area under the curve, 0.67 [95% CI, 0.64-0.69] versus 0.71 [95% CI, 0.69-0.74]; P=0.025). In the subgroup of patients with a CTA available (n=895, 36.3%), the added value of hypodensities remained statistically significant (area under the curve, 0.68 [95% CI, 0.64-0.73] versus 0.74 [95% CI, 0.70-0.78]; P=0.041) whereas the addition of the CTA spot sign did not provide significant discrimination improvement (area under the curve, 0.74 [95% CI, 0.70-0.78]). Conclusions:Noncontrast computed tomography hypodensities provided a significant added value in the prediction of HE and appear a valuable alternative to the CTA spot sign. Our findings might inform future studies and suggest the possibility to stratify the risk of HE with good discrimination without CTA."

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