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Computed Tomography Imaging Predictors of Intracerebral Hemorrhage Expansion

  • Critical Care (S.A. Mayer, Section Editor)
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Abstract

Purpose of Review

Hematoma expansion (HE) is strongly associated with poor clinical outcome and is a compelling target for improving outcome after intracerebral hemorrhage (ICH). Non-contrast computed tomography (NCCT) is widely used in clinical practice due to its faster acquisition at the presence of acute stroke. Recently, imaging markers on NCCT are increasingly used for predicting HE. We comprehensively review the current evidence on HE prediction using NCCT and provide a summary for assessment of these markers in future research studies.

Recent Findings

Predictors of HE on NCCT have been described in reports of several studies. The proposed markers, including swirl sign, blend sign, black hole sign, island sign, satellite sign, and subarachnoid extension, were all significantly associated with HE and poor outcome in their small sample studies after ICH.

Summary

In summary, the optimal management of ICH remains a therapeutic dilemma. Therefore, using NCCT markers to select patients at high risk of HE is urgently needed. These markers may allow rapid identification and provide potential targets for anti-HE treatments in patients with acute ICH.

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Abbreviations

ICH:

Intracerebral hemorrhage

GCS:

Glasgow Coma Scale

IVH:

Intraventricular hemorrhage

HE:

Hematoma expansion

CTA:

Computed tomographic angiography

NCCT:

Noncontrast computed tomography

PHE:

Perihematomal edema

MIS:

Minimally invasive surgery

HU:

Hounsifield unit

ROC:

Receiver operating characteristic

AUC:

Area under the curve

MLF:

Midline shift

CAA:

Cerebral amyloid angiopathy

SAHE:

Subarachnoid extension

cSS:

Cortical superficial siderosis

MRI:

Magnetic resonance imaging

MCTAV:

Minimal computed tomography attenuation value

ROI:

Region of interest

CI:

Confidence interval

CT:

Computed tomography

INTERACT-1:

The Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial 1

NTERACT-2:

The Second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial

ATACH-2:

The Antihypertensive Treatment of Acute Cerebral Hemorrhage

PREDICT:

The Prediction of Hematoma Growth and Outcome in Patients With Intracerebral Hemorrhage Using the CT-Angiography Spot Sign

FAST:

The Factor VII for Acute hemorrhagic Stroke Trial

MISTIE:

The Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation.

References

Papers of particular interest, published recently, have been highlighted as:•• Of major importance

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Funding

This study was supported by grants from the National Key R&D Program of China (No. 2018YFC1312200, No.2018YFC1312203) and the Chongqing High-end Young Investigator Project (No. 2019GDRC005).

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  1. Xin-Ni Lv and Lan Deng contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Xin-Ni Lv, Lan Deng, Wen-Song Yang & Qi Li

  2. Department of Traditional Chinese Medicine, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, China

    Xiao Wei

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  1. Xin-Ni Lv
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  2. Lan Deng
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Lv, XN., Deng, L., Yang, WS. et al. Computed Tomography Imaging Predictors of Intracerebral Hemorrhage Expansion. Curr Neurol Neurosci Rep 21, 22 (2021). https://doi.org/10.1007/s11910-021-01108-z

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