Perihematoma Edema And Other Common CT Signs As Predictors Of Early Hematoma Expansion In Spontaneous Intracerebral Hemorrhage

BackgroundNon-contrast CT scan is essential for the diagnosis of intracerebral hemorrhage(ICH).Early hematoma expansion(HE)is closely correlated with poor outcome.Prediction of HE by non-contrast CT scan provides a therapeutic opportunity for high-risk patients.The study aimed to investigate the potential of perihematoma edema(PHE)as a novel imaging marker to predict early HE,and to examine common CT signs in predicting early HE.MethodsThis was a retrospective cohort study,in which participants from Cerebral Small Vessel Disease Cohort launched by Peking Union Medical College Hospital were consecutively included from August,2016 to August,2018.The admission CT scan was obtained within 6 hours from onset of disease,and follow-up CT scan was acquired within 30 hours after admission CT scan had been finished.Early HE was defined as absolute volume increased>6ml or relative volume increased>33%.The PHE volume and irregularity were tested for HE prediction.To the best of our knowledge,this was the first study that PHE irregularity was described and scaled(0-4 points).Common CT signs,including blend sign,hypodensity,island sign,satellite sign,and hematoma irregularity,were examined for their predictive performances.Univariate analysis was used to find potential factors related to HE.Multivariate analysis was applied to seek independent risk factors of HE.ResultsA total of 130 patients with ICH were included,and 43(33.1%)of them suffered HE.The median PHE volume was 13.5ml,and the median score of PHE irregularity was 1 point.Of included patients,43.1%had blend sign,56.9%had hypodensity,28.5%had island sign,17.7%had satellite sign,and the median grade of hematoma irregularity was 2.The overall volume of hematoma and PHE was larger in HE group compared with non-HE group(36.5ml vs.25.2ml,P=0.053).The rates of blend sign(65.1%vs.32.2%,P<0.001),island sign(41.9%vs.21.8%,P=0.017),and hypodensity(72.1%vs.49.4%,P=0.014)in HE group were significantly higher compared with non-HE group.Both PHE(P=0.051)and hematoma irregularities(P=0.044)correlated with HE.Compared with non-HE,hematoma volume at admission(20.4ml vs.12.7ml,P=0.068),blood pressure(systolic blood pressure 182mmHg vs.167mmHg,P=0.006;diastolic blood pressure 108mmHg vs.99mmHg,P=0.003;mean arterial pressure 133mmHg vs.121mmHg,P=0.001),neutrophil-to-lymphocyte ratio(7.33 vs.4.40,P=0.009),HGB(142g/L vs.135g/L,P=0.029),PT(11.2s vs.11.0s,P=0.080),and blood glucose(6.4mmol/L vs.5.9mmol/L,P=0.026)were significantly higher in HE group;while absolute lymphocyte count(1.01*10^9/L vs.1.42*10^9/L,P=0.002),and female ratio(18.6%vs.39.1%,P=0.019)were significantly lower in HE group.In multivariate analysis,blend sign(OR 3.3,95%CI[1.451,7.506],P=0.004),absolute lymphocyte count(OR 0.89 for 0.1*10^9/L cells increase,95%CI[0.816,0.970],P=0.008,and mean arterial pressure(OR 1.034,95%CI[1.011,1.058],P=0.003)were independent predictors of HE.ConclusionResults of our study demonstrated that PHE volume and irregularity were not independent risk factors of early HE.Blend sign was an independent risk factor of early HE.Additionally,increasing absolute lymphocyte count at admission was a protective factor of early HE.