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Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT.

Methods

After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h.

Results

The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58–0.80) and 0.59 (0.46–0.72) for NCCT score, significantly lower than 0.75 ([0.64–0.87], p = 0.038) and 0.72 ([0.59–0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68–0.89], p = 0.033) and 0.73 ([0.62–0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ2 statistic 0.389, p = 0.533; and χ2 statistic 0.352, p = 0.553), single-phase CTA (χ2 statistic 2.052, p = 0.359; and χ2 statistic 2.230, p = 0.328), and multiphase CTA (χ2 statistic 0.559, p = 0.455; and χ2 statistic 0.020, p = 0.887) scores, respectively.

Conclusion

This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios.

Key Points

• This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation.

• The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers.

• Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.

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Abbreviations

GCS :

Glasgow coma scale

ICH:

Intracerebral hemorrhage

mRS:

Modified Rankin scale

NCCT:

Non-contrast computed tomography

uHG:

Ultraearly hematoma growth

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Neurology, Vall d’Hebron University Hospital, Ps Vall d’Hebron 119, 08035, Barcelona, Spain

    David Rodriguez-Luna, Federica Rizzo, Marta Olivé-Gadea, Manuel Requena, Álvaro García-Tornel, Noelia Rodríguez-Villatoro, Jesús M. Juega, Sandra Boned, Marián Muchada, Jorge Pagola, Marta Rubiera, Marc Ribo & Carlos A. Molina

  2. Stroke Research Group, Vall d’Hebron Research Institute, Barcelona, Spain

    David Rodriguez-Luna, Olalla Pancorbo, Prudencio Lozano, Federica Rizzo, Marta Olivé-Gadea, Manuel Requena, Álvaro García-Tornel, Noelia Rodríguez-Villatoro, Jesús M. Juega, Sandra Boned, Marián Muchada, Jorge Pagola, Marta Rubiera, Marc Ribo & Carlos A. Molina

  3. Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain

    David Rodriguez-Luna & Olalla Pancorbo

  4. Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain

    Pilar Coscojuela & Alejandro Tomasello

Authors
  1. David Rodriguez-Luna
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  2. Olalla Pancorbo
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  3. Pilar Coscojuela
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  6. Marta Olivé-Gadea
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  7. Manuel Requena
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  9. Noelia Rodríguez-Villatoro
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  10. Jesús M. Juega
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  13. Jorge Pagola
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  14. Marta Rubiera
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  15. Marc Ribo
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  17. Carlos A. Molina
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Corresponding author

Correspondence to David Rodriguez-Luna.

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Guarantor

The scientific guarantor of this publication is David Rodriguez-Luna.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

David Rodriguez-Luna has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) or their relatives in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in Rodriguez-Luna D, Coscojuela P, Rodriguez-Villatoro N, et al (2017) Multiphase CT Angiography Improves Prediction of Intracerebral Hemorrhage Expansion. Radiology 285:932–940.

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Rodriguez-Luna, D., Pancorbo, O., Coscojuela, P. et al. Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities. Eur Radiol 33, 6045–6053 (2023). https://doi.org/10.1007/s00330-023-09621-0

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  • DOI: https://doi.org/10.1007/s00330-023-09621-0

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