Research advances in imaging markers for predicting hematoma expansion in intracerebral hemorrhage: a narrative review

Abstract

IntroductionStroke is a major global health concern and is ranked as the second leading cause of death worldwide, with the third highest incidence of disability. Intracerebral hemorrhage (ICH) is a devastating form of stroke that is responsible for a significant proportion of stroke-related morbidity and mortality worldwide. Hematoma expansion (HE), which occurs in up to one-third of ICH patients, is a strong predictor of poor prognosis and can be potentially preventable if high-risk patients are identified early. In this review, we provide a comprehensive summary of previous research in this area and highlight the potential use of imaging markers for future research studies.Recent advancesImaging markers have been developed in recent years to aid in the early detection of HE and guide clinical decision-making. These markers have been found to be effective in predicting HE in ICH patients and include specific manifestations on Computed Tomography (CT) and CT Angiography (CTA), such as the spot sign, leakage sign, spot-tail sign, island sign, satellite sign, iodine sign, blend sign, swirl sign, black hole sign, and hypodensities. The use of imaging markers holds great promise for improving the management and outcomes of ICH patients.ConclusionThe management of ICH presents a significant challenge, and identifying high-risk patients for HE is crucial to improving outcomes. The use of imaging markers for HE prediction can aid in the rapid identification of such patients and may serve as potential targets for anti-HE therapies in the acute phase of ICH. Therefore, further research is needed to establish the reliability and validity of these markers in identifying high-risk patients and guiding appropriate treatment decisions.

Black hole sign migration in short-term brain CT scans: A possible link with clot evolution and histology

“…On considering the elevated morbidity rates, surgical interventions are typically confined to addressing the drainage of subsequent hydrocephalus [3] . Recently, diverse neuroradiological signs have been delineated through various imaging modalities, as outlined by Huang and colleagues [4] . When dealing with ICH, computer tomography (CT) scan is typically the first imaging modality performed.…”

Research advances in predicting the expansion of hypertensive intracerebral hemorrhage based on CT images: an overview

“…It has important value in the diagnosis, localization, and hematoma quantification of HICH ( Romero & Rojas-Serrano, 2023 ). In the past, many studies and clinical practice had proved that some CT imaging signs are independent predictors of HE, such as “blend sign”, “black hole sign”, “island sign” and “swirl sign” ( Al-Ajlan et al, 2023 ; Huang et al, 2023b ). However, the above signs are not common in clinical practice.…”