NCCT Markers of Intracerebral Hemorrhage Expansion Using Revised Criteria: An External Validation of Their Predictive Accuracy
Célina Ducroux, Ahmad Nehme, Bastien Rioux, M Panzini, Robert Fahed, Laura Gioia, Laurent Létourneau‐Guillon
Abstract
<h3>BACKGROUND AND PURPOSE:</h3> Several NCCT expansion markers have been proposed to improve the prediction of hematoma expansion. We retrospectively evaluated the predictive accuracy of 9 expansion markers. <h3>MATERIALS AND METHODS:</h3> Patients admitted for intracerebral hemorrhage within 24 hours of last seen well were retrospectively included from April 2016 to April 2020. The primary outcome was revised hematoma expansion, defined as any of a ≥6-mL or ≥33% increase in intracerebral hemorrhage volume, a ≥ 1-mL increase in intraventricular hemorrhage volume, or de novo intraventricular hemorrhage. We assessed the predictive accuracy of expansion markers and determined their association with revised hematoma expansion. <h3>RESULTS:</h3> We included 124 patients, of whom 51 (41%) developed revised hematoma expansion. The sensitivity of each marker for the prediction of revised hematoma expansion ranged from 4% to 78%; the specificity, 37%–97%; the positive likelihood ratio, 0.41–7.16; and the negative likelihood ratio, 0.49–1.06. By means of univariable logistic regressions, 5 markers were significantly associated with revised hematoma expansion: black hole (OR = 8.66; 95% CI, 2.15–58.14; <i>P</i> = .007), hypodensity (OR = 3.18; 95% CI, 1.49–6.93; <i>P</i> = .003), blend (OR = 2.90; 95% CI, 1.08–8.38; <i>P</i> = .04), satellite (OR = 2.84; 95% CI, 1.29–6.61; <i>P</i> = .01), and Barras shape (OR = 2.41, 95% CI; 1.17–5.10; <i>P</i> = .02). In multivariable models, only the black hole marker remained independently associated with revised hematoma expansion (adjusted OR = 5.62; 95% CI, 1.23–40.23; <i>P</i> = .03). <h3>CONCLUSIONS:</h3> No single NCCT expansion marker had both high sensitivity and specificity for the prediction of revised hematoma expansion. Improved image-based analysis is needed to tackle limitations associated with current NCCT-based expansion markers.