CT Mean HU Of Hematoma And Hematoma Shape Regularity Index In Predicting Hematoma Expansion In Patients With Intracerebral Hemorrhage

Objective:Hematoma expansion（HE）is a factor that seriously affects the prognosis of intracerebral hemorrhage（ICH）.In this study,3Dslicer software was used to quantify the shape and density of hematoma at the same time,combined with the laboratory examination and clinical data at admission,to explore the value of hematoma surface regularity index（SR）and CT（Computed Tomography）mean HU of hematoma in predicting hematoma expansion.Methods:This study retrospectively analyzed 249 ICH patients who met the enrollment criteria in Yulin First Hospital from June 2018 to December 2020.The CT images were obtained from the picture archiving and communication system（PACS）of Yulin First Hospital.Patients with the time to baseline NCCT less than 24 h and time to follow-up CT less than 72 h were included.The CT scans were in Digital Imaging and Communications in Medicine（DICOM）format.3D Slicer software was used for the calculation of the hematoma volume（V）,surface area（S）and the mean HU according to the reconstructed 3D image.The Shape Regularity Index is defined as,SR=^1/3（6）^2/3/,where S is the surface area of the hematoma volume,V is the volume of the hematoma.Hematoma expansion was defined as an increase in hematoma volume by over 33%or 6m L.The enrolled patients were divided into those with hematoma expansion（n=58）and those without the expansion（n=192）.Hematoma expansion was defined as an increase in hematoma volume by over 33%or 6 m L.Clinical data were recorded at the time of admission,included age,sex,systolic blood pressure（SBP）,diastolic blood pressure（DBP）.The information of Glasgow Coma Scale score（GCS）was collected.The data of red blood cell（RBC）count,white blood cell count（WBC）,platelet count,neutrophil percentage（N%）and random blood glucose,glycosylated hemoglobin,blood electrolytes（sodium,potassium,chloride,calcium）,prothrombin time,activated partial thromboplastin time（APTT）,fibrinogen were obtained.We used binary logistic regression to determine the independent determinants of hematoma expansion.In binary logistic regression analysis,factors with P<0.05 in the univariate analysis and those known to be associated with hematoma expansion as confounders were included.The optimal cutoff was determined using the receiver operating characteristic（ROC）curve analysis,and the predictive value of the discriminant score was determined using the area under the receiver operating characteristic（AUC）curve analysis.Results:1.The study included 249 patients who met the inclusion criteria,58（23.3%）patients with hematoma expansion.The mean HU of hematoma was lower in patients with hematoma expansion than with no expansion（58.5±3.2 HU vs 60.3±3.3HU,p<0.01）.The multivariate logistic regression analysis revealed that time from onset to the first CT（P=0.004）,the initial hematoma volume（P<0.001）,and the mean HU of hematoma（P<0.001）were independent predictors of hematoma expansion.By evaluating the receiver operating characteristic curve,the area under the curve of the mean HU of the hematoma predicted hematoma expansion was 0.652（95%CI0.573～0.731,P<0.001）.When the mean HU of hematoma is 57.97,the Youden index is the largest（0.259）,the sensitivity was 50%,and the specificity was 75.9%.The results showed that the mean HU of hematoma<57.97 was independently associated with HE odds ratio（OR）=3.064（95%CI,1.663–5.664,P<0.001）,and the sensitivity,specificity,PLR,NLR,PPV,NPV,and AUC of the HU<57.97HU for HE prediction were 50%（95%CI,36.7–63.3%）,75.39%（95%CI,68.5–81.2%）,2.03（95%CI,1.4–2.9）,0.66（95%CI,0.51–0.86）,38.2%（95%CI,27.5–50.1%）、16.7%（95%CI,11.7–23.4%）.2.The SR index of hematoma was lower in patients with hematoma expansion than with no expansion（0.615±0.146 vs 0.688±0.100,p<0.001）,but the hematoma SR index could not independently predict the hematoma expansion.Conclusions:The CT mean HU of hematoma is an independent predictor of hematoma expansion in ICH patients.The CT mean HU of hematoma<57.97 HU was a potential cutoff.The hematoma SR index was lower in patients with hematoma expansion than with no expansion,but the hematoma SR index could not independently predict hematoma expansion.