Analysis On CT Imaging Of Early Hematoma Expansion In Cerebral Hemorrhage

Background and Objectives:As one of complications of intracerebral haemorrhage(ICH),the hematoma expansion is an important risk factor for early neurological deterioration and poor prognosis.Therefore,the prediction of early hematoma growth has essential guiding significance to improve the poor functional outcome.In this study,the patients of acute ICH was divided into hematoma expansion(HE)group and non-hematoma expansion(non-HE)group.We analyzed the clinical characteristics and cerebral CT imagings between two groups to explore the relationship of the outcome with the early hematoma expansion.Methods:Patients within 12 h after stroke attack was enrolled in the emergency department of People`s Hospital of Henan Province between January 2012 to June 2016.Sex,age,medical histories,time from onset to admission CT,systolic blood pressure(SBP)and diastolic blood pressure(DBP)on admission,admission NIHSS and GCS scores,CT features(hematoma volume,shape and location,ruptured into the ventricle and CT blank hole sign)in the initial CT and the followed CT within 48 h was recorded.Hematoma expansion was defined as an relative increase in volume above 33% between the initial CT and the followed CT.Statistical analysis was done by SPSS 17.0 software.The continuous variables are presented as means and SD or medians and interquartile ranges(IQR),and the categorical variables are presented as percentages.Comparison of continuous variables intergroup was assessed by Student`t or Mann Whitney U test,and categorical variables was assessed by ?2 or the Fisher exact test.Multivariable logistic regression analyses were performed to determine factors that could be considered as independent predictors of hematoma expansion,the results are presented as odds ratio(OR)and 95% confidence interval(CI).We calculated the sensitivity,specificity,positive predictive value and negative predictive of predicting hematoma expansion.A p value of 0.05 was considered significant for all tests.Results:185 patients with ICH were enrolled,including 70(37.8%)patients in HE group and 115(62.2%)patients in non-HE group.There were no significant difference between the two groups in sex,age,SBP and DBP on admission,admission GCS score,medical histories,smoking and drinking histories(P >0.05);patients in HE group had a higher admission NIHSS score(P =0.033)and a shorter time from onset to admission CT(P =0.043)compared with non-HE group.In single factor comparisons on CT,there were no significant difference in hematoma location and initial intraventricular hemorrhage expansion between the two groups;there were significant difference in initial hematoma hematoma volume,irregular morphology,CT black hole sign and delayed intraventricular hemorrhage expansion(P = 0.013,0.006,P <0.001 and P = 0.001).Multivariable logistic regression analysis showed irregular hematoma shape,CT black hole sign and delayed intraventricular hemorrhage expansion were independent predictors for early hematoma enlargement with that the sensitivity and specificity were respectively 71.45% and 54.78%,51.4% and 81.7%,23.07% and 71.3%.Conclusion:Irregular hematoma shape,CT sign black hole and delayed intraventricular hemorrhage expansion are the independent predictors of early hematoma enlargement.Irregular hematoma shape has the higher sensitivity and CT sign black hole has the highest specificity.