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Imaging-based outcome prediction in patients with intracerebral hemorrhage

  • Review Article - Neurosurgery general
  • Published:
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Abstract

Besides the established spot sign in computed tomography angiography (CTA), recently investigated imaging predictors of hematoma growth in noncontrast computed tomography (NCCT) suggest great potential for outcome prediction in patients with intracerebral hemorrhage (ICH). Secondary hematoma growth is an appealing target for therapeutic interventions because in contrast to other determined factors, it is potentially modifiable. Even more initial therapy studies failed to demonstrate clear therapeutic benefits, there is a need for an effective patient selection using imaging markers to identify patients at risk for poor outcome and thereby tailor individual treatments for every patient. Hence, this review gives an overview about the current literature on NCCT imaging markers for neurological outcome prediction and aims to clarify the association with the established spot sign. Moreover, it demonstrates the clinical impact of these parameters and gives a roadmap for future imaging research in patients with intracerebral hemorrhage.

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Authors and Affiliations

  1. Institute of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany

    Peter B. Sporns & Walter Heindel

  2. Institute of Neuroradiology, University Hospital of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany

    André Kemmling

  3. Department of Neurology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany

    Jens Minnerup

  4. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Uta Hanning

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  1. Peter B. Sporns
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  2. André Kemmling
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  3. Jens Minnerup
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  4. Uta Hanning
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  5. Walter Heindel
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Correspondence to Peter B. Sporns.

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Defining risk factors which may lead signify high risk of progression of intracerebral hemorrhage is necessary in order to best determine which patients need intensive care monitoring and possible neurosurgical interventions. The authors in this paper sought to review common radiologic signs using noncontrast computed tomography which can serve as markers to identify patients at risk for progression of hemorrhage. The authors discuss several radiological signs which have been discussed in the literature as potential markers for hematoma growth, and describe the classic spot sign as a standard radiographic marker that correlates with hematoma expansion.

One of the major goals of the article is to describe more recently described imaging findings which may predict progression of intracerebral hematoma and to clarify their association with the spot sign. The authors were able to establish this for the hematoma blend sign and black hole sign. They then described several other signs which have been shown to have value in prediction of for hematoma expansion.

The included table within the article quickly summarizes the literature for each radiographic sign, including each sign’s predictive value for hematoma expansion. This greatly improves the readability of the article.

Overall, the paper serves as a thorough review useful to neurosurgeons, neurologists, and neuroradiologists in the treatment and care of patients with intracranial hemorrhage.

Lauren Stone, Joel Passer, Christopher M. Loftus

Philadelphia, PA, USA

This article is part of the Topical Collection on Neurosurgery general

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Sporns, P.B., Kemmling, A., Minnerup, J. et al. Imaging-based outcome prediction in patients with intracerebral hemorrhage. Acta Neurochir 160, 1663–1670 (2018). https://doi.org/10.1007/s00701-018-3605-x

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