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Minimal Computed Tomography Attenuation Value Within the Hematoma is Associated with Hematoma Expansion and Poor Outcome in Intracerebral Hemorrhage Patients

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An Invited Editorial Commentary to this article was published on 19 June 2019

Abstract

Background

Early hematoma expansion in intracerebral hemorrhage (ICH) patients is associated with poor outcome. We aimed to investigate whether the minimal computed tomography (CT) attenuation value predicted hematoma expansion and poor outcome.

Methods

This study involved spontaneous ICH patients of two cohorts who underwent baseline CT scan within 6 h after ICH onset and follow-up CT scan within 24 h after initial CT scan. We determined the critical value of the minimal CT attenuation value via retrospective analysis of the data from a derivation cohort. Then, a prospective study on the validation cohort of three clinical centers was performed for determining the association between the minimal CT attenuation value and hematoma expansion as well as poor outcome (modified Rankin Scale scores > 3) at 90 days by using univariate and multivariate logistic regression analyses.

Results

One hundred and forty eight ICH patients were included in the derivation cohort. Minimal CT attenuation value ≤ 31 Hounsfield units (HU) was demonstrated as the critical value to predict hematoma expansion by using receiver operating characteristic analysis. A total of 311 ICH patients were enrolled in the validation cohort, 86 (27.7%) and 133 (42.8%) of which were found hematoma expansion and poor outcome. Minimal CT attenuation value ≤ 31 HU was positive in 73 patients (23.5%). The multivariate logistic regression analysis demonstrated minimal CT attenuation value and minimal CT attenuation value ≤ 31 HU independently predicted hematoma expansion (p < 0.001) and poor outcome (p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of minimal CT attenuation value ≤ 31 HU for hematoma expansion and poor outcome prediction were 64.0, 92.0, 75.3, 87.0, 84.2 and 45.1%, 92.7%, 82.2%, 69.3%, 72.3%, respectively.

Conclusions

The minimal CT attenuation value independently predicts early hematoma expansion and poor outcome in patients with ICH.

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Author information

Author notes

  1. Heling Chu and Chuyi Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 Mid. Wulumuqi Road, Shanghai, 200040, China

    Heling Chu, Jing Dong, Yiting Mao, Qiang Dong & Yuping Tang

  2. Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai, 200120, China

    Chuyi Huang

  3. Department of Neurology, Jinshan Hospital, Fudan University, No. 1508 Longhang Road, Shanghai, 201508, China

    Xiaobo Yang

  4. Department of Chinese Integrative Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China

    Jun Xiang

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  1. Heling Chu
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Contributions

HC and CH contributed to study design, data collection, and analysis and drafting of the manuscript. JD, XY, JX, and YM involved in data collection and analysis. QD and YT took part in conception and design, acquisition of clinical data, revision and approval of the manuscript. All authors gave the final approval of the version to be published. Authorship requirements have been met, and the final manuscript was approved by all authors. This manuscript has not been published elsewhere and is not under consideration by another journal.

Corresponding authors

Correspondence to Qiang Dong or Yuping Tang.

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Source of Support

This research was supported by grants from the National Natural Science Foundation of China (Nos. 81500998; 81701244; 81801290), Science and Technology Commission of Shanghai Municipality (No. 16140903200), and Shanghai Sixth People’s Hospital Medical Group (2017LY01).

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval/Informed Consent

All patients or their next-of-kin gave their informed consent prior to inclusion in this study. This study was approved by and studied in accordance with the ethical standards of the Ethics Committee of Fudan University.

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Chu, H., Huang, C., Dong, J. et al. Minimal Computed Tomography Attenuation Value Within the Hematoma is Associated with Hematoma Expansion and Poor Outcome in Intracerebral Hemorrhage Patients. Neurocrit Care 31, 455–465 (2019). https://doi.org/10.1007/s12028-019-00754-z

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