Prevalence of Hematoma Expansion and Signs in Non-contrast Computed Tomography for Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage at Siriraj Hospital

Abstract

Introduction: Hematoma expansion (HE) in intracerebral hemorrhage (ICH), defined by over 33% or > 6 ml volume increase, often leads to poor outcomes and mortality. This study aims to examine non-contrast computed tomography (NCCT) indicators for HE prediction and their associations with patient clinical data and HE occurrence.

Methods: We retrospectively analyzed data and measured HE by using image analysis software in NCCT images including initial and follow-up scan at <7 days from 169 patients during Jan 2013 - Aug 2019 in Siriraj Hospital.

Results: HE was found in 44 of the 169 patients with spontaneous ICH (26%), occurring in two periods: at 10–25 h (peak 7 h) and at 50–75 h (peak 50 h). Atrial Fibrillation (AF) and anticoagulant use were more prevalent in the HE group (15.9% and 20.5%) compared to the non-HE group (4.8% and 7.2%, p = 0.042 and p = 0.022). HE was linked to increased 60-day and 90-day mortality (29% and 32.3%, p = 0.016 and p = 0.010) and decreased time to follow-up scan (median = 21 h and 48 h). Satellite sign, heterogeneous density, intra-hematoma hypodensity, and fluid level prevalence were 46.2%, 35.5%, 21.9%, and 4.1%, but only heterogeneous density and intra-hematoma hypodensity were significantly associated with HE (p =0.003 and p =0.011), with heterogeneous density being an independent predictor (OR, 2.4; 95% CI, 1.2-5.1, p = 0.019) according to logistic regression analysis.

Conclusions: Heterogeneous density in NCCT is found as an independent predictor of HE among other significant HE-associated findings, which included heterogeneous density, intra-hematoma hypodensity, and various clinical data. Two peaks in expansion activity related to HE development were noted, a novel finding in this study, emphasizes the importance of delayed follow-up NCCT.