Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion-Reference-Cited by-同舟云学术

Using Noncontrast Computed Tomography to Improve Prediction of Intracerebral Hemorrhage Expansion

Published:2023-02 Issue:2 Volume:54 Page:567-574
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Morotti Andrea¹^ORCID,Boulouis Gregoire²^ORCID,Nawabi Jawed³⁴^ORCID,Li Qi⁵⁶^ORCID,Charidimou Andreas⁷⁸^ORCID,Pasi Marco⁹^ORCID,Schlunk Frieder⁴¹⁰,Shoamanesh Ashkan¹¹^ORCID,Katsanos Aristeidis H.¹¹^ORCID,Mazzacane Federico¹²^ORCID,Busto Giorgio¹³,Arba Francesco¹⁴^ORCID,Brancaleoni Laura¹⁵^ORCID,Giacomozzi Sebastiano¹⁵^ORCID,Simonetti Luigi¹⁶^ORCID,Warren Andrew D.⁸^ORCID,Laudisi Michele¹⁷^ORCID,Cavallini Anna¹²^ORCID,Gurol Edip M.⁸^ORCID,Viswanathan Anand⁸^ORCID,Zini Andrea¹⁵^ORCID,Casetta Ilaria¹⁷^ORCID,Fainardi Enrico¹³^ORCID,Greenberg Steven M.⁸^ORCID,Padovani Alessandro¹⁸,Rosand Jonathan⁸¹⁹²⁰^ORCID,Goldstein Joshua N.⁸²⁰²¹^ORCID

Affiliation:

1. Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy (A.M.).

2. Neuroradiology Department, University Hospital of Tours, CEDEX 09, Tours, France (G.B.).

3. Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health, Germany (J.N.).

4. Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Germany (J.N., F.S.).

5. Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, China (Q.L.).

6. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, China (Q.L.).

7. Department of Neurology, Boston University School of Medicine, MA (A.C.).

8. J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (A.C., A.D.W., E.M.G., A.V., S.M.G., J.R., J.N.G.).

9. Neurology Department, University Hospital of Tours, CEDEX 09, France (M.P.).

10. Department of Neuroradiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany (F.S.).

11. Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada (A.S., A.H.K.).

12. U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italia (F.M., A.C.).

13. Department of Biomedical Experimental and Clinical, Neuroradiology, University of Firenze, AOU Careggi, Firenze, Italy (G.B., E.F.).

14. Stroke Unit, AOU Careggi, Firenze, Italia (F.A.).

15. IRCCS Istituto delle Scienze Neurologiche di Bologna,UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italia (L.B., S.G., A.Z.).

16. IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità di Neuroradiologia, Ospedale Maggiore, Bologna, Italia (L.S.).

17. Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara, Italia (M.L., I.C.).

18. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy (A.P.).

19. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R.).

20. Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R., J.N.G.).

21. Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.).

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference33 articles.

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