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Congress: ECR25
Poster Number: C-10714
Type: Poster: EPOS Radiologist (scientific)
Authorblock: R. Agarwal, R. Thakka, S. Chikatla, A. Kalegowda; Bengaluru/IN
Disclosures:
Ritika Agarwal: Nothing to disclose
Rajeshwari Thakka: Nothing to disclose
Sowmya Chikatla: Nothing to disclose
Anand Kalegowda: Nothing to disclose
Keywords: CNS, Emergency, Neuroradiology brain, CT, CT-High Resolution, CT-Quantitative, Computer Applications-Detection, diagnosis, Haemorrhage, Hypertension
Purpose Hematoma expansion complicates intracerebral hemorrhage (ICH) management and worsens outcomes, making early identification critical. Non-contrast computed tomography (NCCT) markers (e.g., blend sign, black hole sign, swirl sign, island sign, satellite sign, hypodensities, fluid level, heterogeneous density, irregular shape) have been proposed as predictors of hematoma expansion. The study aimed to evaluate the predictive accuracy of NCCT markers using revised hematoma expansion (RHE) criteria and assess their utility for early risk stratification.
Read more Methods and materials ICH accounts for 10–15% of strokes but contributes to nearly half of stroke-related deaths. (1) Hematoma expansion (HE) occurs in up to 38% of cases in the early phase and worsens outcomes. (1) Traditional HE definitions focus on parenchymal hematoma growth, neglecting intraventricular hemorrhage growth (IVHG), which impacts prognosis. Revised hematoma expansion (RHE) criteria, (2, 3) incorporating IVHG, offer improved predictive accuracy. NCCT is a widely accessible imaging modality that provides critical information about hematoma characteristics. The study explored the role of NCCT markers in...
Read more Results Patient Demographics:  150 patients; mean age 61.17 ± 15.36 years; 56% male. Smoking (24%), alcohol use (20%), diabetes (42%), and hypertension (57.3%) were common. Hematoma Expansion (RHE): RHE occurred in 74 patients (49.3%). RHE group had higher prevalence of smoking (54.1% vs. 21.1%), alcohol use (50% vs. 13.2%), diabetes (59.4% vs. 25%), and hypertension (70.2% vs. 44.7%). The median GCS score was lower in RHE group compared to non- RHE group. Baseline ICH volume was larger in RHE group (18.92 ± 18.14 mL vs. 13.65 ± 15.32...
Read more Conclusion Hypodensity is the most consistent and reliable predictor of RHE, with high sensitivity across gangliocapsular and peripheral lobar bleeds. Additional markers (e.g., swirl sign, irregular shape) also predict RHE, with swirl sign showing the highest specificity and positive predictive value. Fluid level is a significant predictor in peripheral lobar bleeds. Early neuroimaging with NCCT markers enhances risk stratification and guides timely interventions. Integrating these markers into clinical protocols can improve predictive accuracy and patient outcomes in ICH management.
Read more References Brott T, Broderick J, Kothari R, Barsan W, Tomsick T, Sauerbeck L, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5. doi: 10.1161/01.str.28.1.1 Yogendrakumar V, Ramsay T, Fergusson DA, Demchuk AM, Aviv RI, Rodriguez-Luna D, et al. Redefining hematoma expansion with the inclusion of intraventricular hemorrhage growth. Stroke 2020;51:1120–1127. Yang WS, Zhang SQ, Shen YQ, Wei X, Zhao LB, Xie XF, et al. Noncontrast computed tomography markers as predictors of revised hematoma expansion in acute intracerebral hemorrhage. J Am...
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