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

ObjectivesTo 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.MethodsAfter 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.ResultsThe 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 (chi(2) statistic 0.389, p = 0.533; and chi(2) statistic 0.352, p = 0.553), single-phase CTA (chi(2) statistic 2.052, p = 0.359; and chi(2) statistic 2.230, p = 0.328), and multiphase CTA (chi(2) statistic 0.559, p = 0.455; and chi(2) statistic 0.020, p = 0.887) scores, respectively.ConclusionThis 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.

Automated summary

This study aims to derive and validate scores for predicting intracerebral hemorrhage (ICH) expansion using non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers. The study found that single-phase and multiphase CTA markers have higher discrimination for predicting substantial hematoma expansion compared to NCCT markers. The three scores showed good calibration in both derivation and validation cohorts.