Association of non-contrast CT markers with long-term functional outcome in deep intracerebral hemorrhage

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Objective Hematoma expansion (HE) is the most important therapeutic target during acute care of patients with intracerebral hemorrhage (ICH). Imaging biomarkers such as non-contrast CT (NCCT) markers have been associated with increasing risk for HE. The aim of the present study was to evaluate the influence of NCCT markers with functional long-term outcome and with HE in patients with deep (basal ganglia and thalamus) ICH who represent an important subgroup of patients at the highest risk for functional deterioration with HE due to the eloquence of the affected brain region. Methods From our prospective institutional database, all patients maximally treated with deep ICH were included and retrospectively analyzed. NCCT markers were recorded at diagnostic imaging, ICH volume characteristics were volumetrically evaluated, and all patients received follow-up imaging within 0–48 h. We explored associations of NCCT makers with unfavorable functional outcome, defined as modified Rankin scale 4–6, after 12 months and with HE. Bias and confounding were addressed by multivariable regression modeling. Results In 322 patients with deep ICH, NCCT markers were distributed as follows: irregular shape: 69.6%, heterogenous density: 55.9%, hypodensities: 52.5%, island sign: 19.3%, black hole sign: 11.5%, and blend sign: 4.7%. Upon multivariable regression analyses, independent associations were documented with the functional outcome for irregular shape (aOR: 2.73, 95%CI: 1.42–5.22, p = 0.002), heterogenous density (aOR: 2.62, 95%CI: 1.40–4.90, p = 0.003) and island sign (aOR: 2.54, 95%CI: 1.05–6.14, p = 0.038), and with HE for heterogenous density (aOR: 5.01, 95%CI: 1.93–13.05, p = 0.001) and hypodensities (aOR: 3.75, 95%CI: 1.63–8.62, p = 0.002). Conclusion NCCT markers are frequent in deep ICH patients and provide important clinical implications. Specifically, markers defined by diverging intra-hematomal densities provided associations with a 5-times higher risk for HE and a 2.5-times higher likelihood for unfavorable functional long-term outcome. Hence, these markers allow the identification of patients with deep ICH at high risk for clinical deterioration due to HE.

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