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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
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 predicting RHE and their association with hematoma characteristics and clinical outcomes.

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    Methodology: 

      • Study Design : This retrospective cohort study was conducted at Ramaiah Hospitals between January 2023 and September 2024.
      • Inclusion Criteria
        • Patients presenting with spontaneous supratentorial intracerebral hemorrhage (ICH) within 24 hours of symptom onset or the last known well time were included.
        • Baseline and follow-up non-contrast computed tomography (NCCT) imaging were required within 72 hours of the initial scan.
      • Exclusion Criteria
        • Patients with secondary causes of ICH, including:
          • Macrovascular abnormalities such as aneurysms or arteriovenous malformations.
          • Traumatic brain injury.
          • Brain neoplasms.
          • Hemorrhagic transformation of ischemic stroke.
        • Patients undergoing neurosurgical interventions, such as hematoma evacuation or ventricular drainage, prior to follow-up imaging were excluded.
      • Hematoma Volume Assessment:
        Fig 1: Example image showing semi-manual segmentation on NCCT and calculation of volume of hematoma.
        • Hematoma volume was measured using semi-manual segmentation of 5-mm NCCT slices by two radiologists.
        • Discrepancies exceeding 1 mL were resolved through mutual discussion to ensure consistency.
      • NCCT Marker Classification:(4)
        Fig 2: Illustrative examples of density-based markers: Hypodensities, swirl sign, black hole sign.
        Fig 3: Illustrative examples of density-based markers: Blend sign, fluid level, heterogeneous density.
        Fig 4: Illustrative examples of shape-based markers: Island sign, satellite sign, irregular shape.
        • Density-Based Markers: Hypodensities, swirl sign, black hole sign, blend sign, fluid level, and heterogeneous density.
        • Shape-Based Markers: Island sign, satellite sign, and irregular shape.
        • Marker evaluations were conducted by two independent blinded reviewers, with disagreements adjudicated by a senior radiologist.
      • Definition of Hematoma Expansion (HE): Hematoma expansion was defined using revised hematoma expansion (RHE) criteria,(2) which included any of the following:
        • Absolute hematoma growth >6 mL.
        • Relative hematoma growth >33%.
        • Intraventricular hemorrhage growth (IVHG) >1 mL.
        • New intraventricular hemorrhage on follow-up imaging.
      • Statistical Analysis:
        • Univariable analyses identified significant predictors (P < 0.05).
        • Multivariable logistic regression identified independent predictors.
        • Sensitivity, specificity, and predictive values of NCCT markers were calculated.
GALLERY