Early Hematoma Enlargement in Primary Intracerebral Hemorrhage

Cao, Du; Li, Qi; Fu, Pei-Chun; Zhang, Junyi; Yang, Jun

doi:10.2174/1389450118666170427151011

“…The increased attenuation value of the hematoma is mainly due to the formation of a meshwork of fibrin fibers, globin molecules, and early clot contraction events after bleeding (5,24), therefore hypodense foci within the hematoma may be the result of repeated bleeding from the primary bleeding site or poor clot contraction and hence the evidence of the potential HE (7,9,17). However, the exact site of hemorrhage, whether it is a primary hemorrhagic vessel (25), or a secondary hemorrhagic vessel (26), is not always within the hypodense foci, but may also be located within the non-hypodense region and appear as a spot sign on contrast CT (6,27). Therefore, the role played by the attenuation value within the non-hypodense region in determining the hemostatic status of the bleeding site is not negligible.…”

Section: Discussionmentioning

confidence: 99%

The Attenuation Value Within the Non-hypodense Region on Non-contrast Computed Tomography of Spontaneous Cerebral Hemorrhage: A Long-Neglected Predictor of Hematoma Expansion

Chen

¹

,

Cao

²

,

Guo

³

et al. 2022

Front. Neurol.

1

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Background and PurposeThe ability of attenuation value of the non-hypodense region of hematoma in non-contrast computed tomography (NCCT) for predicting hematoma expansion (HE) remains unclear. Our purpose is to explore this relationship.MethodsTwo cohorts of patients were collected for analysis. The region where we measured hematoma attenuation values was limited to the non-hypodense region that was not adjacent to the normal brain tissue on NCCT. The critical attenuation value was derived via receiver operating characteristic (ROC) curve analysis in the derivation cohort and its predictive ability was validated in the validation cohort. Independent relationships between predictors, such as critical attenuation value of the non-hypodense region and HE were analyzed using the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic analysis.ResultsThe results showed that the attenuation value <64 Hounsfield units (HU) was independently associated with HE [odds ratio (OR), 4.118; 95% confidential interval (CI), 1.897–9.129, p < 0.001] and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) for predicting HE were 36.11%, 81.71%, 1.97, 0.78, 44.8%, 75.7%, and 0.589, respectively.ConclusionsOur research explored and validated the relationship between the attenuation value of the non-hypodense region of hematoma and HE. The attenuation value < 64 HU was an appropriate indicator of early HE.

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“…[1,3,4,26–28] So, predicting secondary expansion may help to include as many patients as possible who need antiexpansion therapies, such as intensive blood pressure reduction or administration of tranexamic acid. [27,29–32]…”

Section: Discussionmentioning

confidence: 99%

“…[1,3,4,[26][27][28] So, predicting secondary expansion may help to include as many patients as possible who need antiexpansion therapies, such as intensive blood pressure reduction or administration of tranexamic acid. [27,[29][30][31][32] The clinical value of NCCT markers and the CTA spot sign as predictors of ICH expansion has been validated in several studies. [5][6][7][8][9][10][11][12][13][14] He et al compared the black hole sign and other CT features (irregular hematoma and initial hematoma volume) to predict hematoma expansion and outcome.…”

Section: Discussionmentioning

confidence: 99%

The comprehensive comparison of imaging sign from CT angiography and noncontrast CT for predicting intracranial hemorrhage expansion: A comparative study

Chung

¹

,

Goo

²

,

Kwak

³

et al. 2022

Medicine

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Expansion of intracranial hemorrhage (ICH) is an important predictor of poor clinical outcomes. Various imaging markers on non-contrast computed tomography (NCCT) or computed tomographic angiography (CTA) have been reported as predictors of ICH expansion. We aimed to compare the associations between various CT imaging markers and ICH expansion. Patients with spontaneous ICH who underwent initial NCCT, CTA, and subsequent NCCT between January 2016 and December 2019 were retrospectively identified. ICH expansion was defined as a volume increase of > 33% or > 6 mL. We analyzed the presence of imaging markers such as the black hole sign, blend sign, island sign, or swirl sign on initial NCCT or spot sign on CTA. An alternative free-response receiver operating characteristic curve analysis was performed using a 4-point scoring system based on the consensus of the reviewers. The predictive value of each marker was assessed using univariate and multivariate logistic regression analyses. A total of 250 patients, including 60 (24.0%) with ICH expansion, qualified for the analysis. Among the patients with spontaneous ICH, 118 (47.2%) presented with a black hole sign, 52 (20.8%) with a blend sign, 93 (37.2%) with an island sign, 79 (31.6%) with a swirl sign, and 56 (22.4%) with a spot sign. In univariate logistic regression, the initial ICH volume (P = .038), initial intraventricular hemorrhage (IVH) presence (P < .001), swirl sign (P < .001), and spot sign (P < .001) were associated with ICH expansion. Multivariate analysis confirmed that the presence of initial IVH (odds ratio, 4.111; P = .002) and spot sign (odds ratio, 109.5; P < .001) were independent predictors of ICH expansion. Initial ICH volume, IVH, swirl sign, and spot sign are associated with ICH expansion. The presence of spot signs and IVH were independent predictors of ICH expansion.

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“…Intracerebral hemorrhage (ICH) is a type of stroke accounting for about 13%, and it is the localized hemorrhage in surrounding tissues caused by the rupture of cerebral arteries [ 1 ]. ICH can be caused by a variety of causes, including head trauma, hypertension, aneurysm, vascular anomaly, blood diseases or bleeding disorders, liver diseases, and brain tumors [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Early Prediction of Cerebral Computed Tomography under Intelligent Segmentation Algorithm Combined with Serological Indexes for Hematoma Enlargement after Intracerebral Hemorrhage

Xu

¹

,

Tang

²

,

Wu

³

et al. 2022

Computational and Mathematical Methods in Medicine

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The aim of this study was to explore the application value of brain computed tomography (CT) images under intelligent segmentation algorithm and serological indexes in the early prediction of hematoma enlargement in patients with intracerebral hemorrhage (ICH). Fuzzy C -means (FCM) intelligence segmentation algorithm was introduced, and 150 patients with early ICH were selected as the research objects. Patient cerebral CT images were intelligently segmented to assess the diagnostic value of this algorithm. According to different hematoma volumes during CT examination, patients were divided into observation group (hematoma enlargement occurred, n = 48 ) and control group (no hematoma enlargement occurred, n = 102 ). The predicative value of hematoma enlargement after ICH was investigated by assessing CT image quality and measuring intracerebral edema, hematoma volume, and serological indicators of the patients of the two groups. The results demonstrated that the sensitivity, specificity, and accuracy of CT images processed by intelligence segmentation algorithm amounted to 0.894, 0.898, and 0.930, respectively. Besides, early edema enlargement and hematoma of patients in the observation group were more significant than those of patients in the control group. Relative edema volume was 0.912, which was apparently lower than that in the control group (1.017) ( P < 0.05 ). In terms of CT signs of ICH patients, the incidence of blend sign, low density sign, and stroke of the observation group was evidently higher than those of the control group ( P < 0.05 ). Besides, absolute lymphocyte count (ALC) and hemoglobin (HGB) concentration of the patients in the observation group were 6.23 × 109 /L and 6.29 × 109 /L, respectively, both of which were higher than those of the control group ( 6.08 × 109 /L and 4.25 × 109 /L). Neutrophil to lymphocyte ratio (NLR) was 0.99 × 109 /L, which was apparently lower than that in the control group ( 1.43 × 109 /L) ( P < 0.05 ). To sum up, cerebral CT images processed by FCM algorithm showed good diagnostic effect on ICH and high clinical values in the early prediction of hematoma among ICH patients.

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Early Hematoma Enlargement in Primary Intracerebral Hemorrhage

Cited by 10 publications

References 0 publications

The Attenuation Value Within the Non-hypodense Region on Non-contrast Computed Tomography of Spontaneous Cerebral Hemorrhage: A Long-Neglected Predictor of Hematoma Expansion

The Attenuation Value Within the Non-hypodense Region on Non-contrast Computed Tomography of Spontaneous Cerebral Hemorrhage: A Long-Neglected Predictor of Hematoma Expansion

The comprehensive comparison of imaging sign from CT angiography and noncontrast CT for predicting intracranial hemorrhage expansion: A comparative study

Early Prediction of Cerebral Computed Tomography under Intelligent Segmentation Algorithm Combined with Serological Indexes for Hematoma Enlargement after Intracerebral Hemorrhage

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