WSO - July 2023 - 704

1142742
WSO
International Journal of StrokeMorotti et al.
Research
Non-contrast CT markers of
intracerebral hemorrhage expansion:
The influence of onset-to-CT time
Andrea Morotti1 , Qi Li2,3 , Valentina Mazzoleni4,
Jawed Nawabi5,6 , Frieder Schlunk6,7 , Federico Mazzacane8,9,
Giorgio Busto10, Elisa Scola10, Laura Brancaleoni11,
Sebastiano Giacomozzi11, Luigi Simonetti12, Michele Laudisi13,
Anna Cavallini9, Andrea Zini11 , Ilaria Casetta13
,
Enrico Fainardi14, Dar Dowlatshahi15 , Alessandro Padovani1,4
and Francesco Arba16
International Journal of Stroke
2023, Vol. 18(6) 704 -711
© 2022 World Stroke Organization
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/17474930221142742
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930221142742
Abstract
Background: Hematoma expansion (HE) is an appealing therapeutic target in intracerebral hemorrhage (ICH) and noncontrast
computed tomography (NCCT) features are promising predictors of HE.
Aims: We investigated whether onset-to-CT time influences the diagnostic performance of NCCT markers for HE.
Methods: Retrospective multicentre analysis of patients with primary ICH. The following NCCT markers were analyzed:
hypodensities, heterogeneous density, blend sign, and irregular shape. HE was defined as growth ⩾6 mL and/or
⩾33%. We calculated the sensitivity, specificity, positive, and negative predictive values (PPVs and NPVs) of NCCT
markers for HE, stratified by onset-to-CT time (<2 h, 2-4 h, 4-6 h, >6 h).
Results: We included 1135 patients (median age 69, 53% males), of whom 307 (27%) experienced HE.
Overall hypodensities had the highest sensitivity (0.68) and blend sign the highest specificity (0.87) for HE. Hypodensities
were more common and had higher sensitivity (0.80) in patients with imaging within 2 h. The same result was observed
for heterogeneous density, whereas irregular shape had a similar prevalence across time strata and higher sensitivity
1 Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy
2 Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
3 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
4 Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
5 Department of Radiology (CCM), Berlin Institute of Health, Campus Mitte, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin
and Freie Universität Berlin, Berlin, Germany
6 BIH Biomedical Innovation Academy, Berlin Institute of Health (BIH), Berlin, Germany
7 Department of Neuroradiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu
Berlin, Berlin, Germany
8 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
9 U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
10 Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
11 IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
12 IRCCS Istituto delle Scienze Neurologiche di Bologna, UO (SSI) di Neuroradiologia, Ospedale Maggiore, Bologna, Italy
13 Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara and Ospedale Universitario S.
Anna, Ferrara, Italy
14 Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
15 Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
16 Stroke Unit, AOU Careggi, Firenze, Italy
Corresponding author:
Andrea Morotti, Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, P.le Spedali Civili 1, Brescia, 25100, Italy.
Email: andrea.morotti85@gmail.com
International Journal of Stroke, 18(6)
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