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. 2019 Jun;30(3):601-608.
doi: 10.1007/s12028-018-0644-3.

Expansion-Prone Hematoma: Defining a Population at High Risk of Hematoma Growth and Poor Outcome

Qi Li #  1 , Yi-Qing Shen #  2 , Xiong-Fei Xie #  2 , Meng-Zhou Xue  3 , Du Cao  4 , Wen-Song Yang  4 , Rui Li  4 , Lan Deng  4 , Miao Wei  2 , Fa-Jin Lv  2 , Guo-Feng Wu  5 , Zhou-Ping Tang  6 , Peng Xie  7
Affiliations

Expansion-Prone Hematoma: Defining a Population at High Risk of Hematoma Growth and Poor Outcome

Qi Li et al. Neurocrit Care. 2019 Jun.

Abstract

Background: Noncontrast computed tomography (CT) markers are increasingly used for predicting hematoma expansion. The aim of our study was to investigate the predictive value of expansion-prone hematoma in predicting hematoma expansion and outcome in patients with intracerebral hemorrhage (ICH).

Methods: Between July 2011 and January 2017, ICH patients who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. Expansion-prone hematoma was defined as the presence of one or more of the following imaging markers: blend sign, black hole sign, or island sign. The diagnostic performance of blend sign, black hole sign, island sign, and expansion-prone hematoma in predicting hematoma expansion was assessed. Predictors of hematoma growth and poor outcome were analyzed using multivariable logistical regression analysis.

Results: A total of 282 patients were included in our final analysis. Of 88 patients with early hematoma growth, 69 (78.4%) had expansion-prone hematoma. Expansion-prone hematoma had a higher sensitivity and accuracy for predicting hematoma expansion and poor outcome when compared with any single imaging marker. After adjustment for potential confounders, expansion-prone hematoma independently predicted hematoma expansion (OR 28.33; 95% CI 12.95-61.98) and poor outcome (OR 5.67; 95% CI 2.82-11.40) in multivariable logistic model.

Conclusion: Expansion-prone hematoma seems to be a better predictor than any single noncontrast CT marker for predicting hematoma expansion and poor outcome. Considering the high risk of hematoma expansion in these patients, expansion-prone hematoma may be a potential therapeutic target for anti-expansion treatment in future clinical studies.

Keywords: CT predictor; Intracerebral hemorrhage; Outcome; Stroke.

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