Co-localization of NCCT hypodensity and CTA spot sign to predict intracerebral hematoma expansion and severity: development and validation of the Black-&-White sign
Abstract Body: Introduction: Hematoma expansion (HE) occurs in one-fourth of patients with acute intracerebral hematoma (ICH) and is associated with worse outcomes. Existing radiological markers of HE show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE. Methods: We analyzed 200 consecutive acute ICH patients admitted at Foothills Medical Centre in Calgary, Canada (development cohort) and analyzed 304 patients from the multicenter observational study PREDICT (validation cohort). The Black-&-White (B&W) sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT (Figure 1). The primary outcome was hematoma expansion (≥6mL or ≥33%). Secondary outcomes included absolute (<3mL, 3-6mL, 6-12mL, ≥12mL) and relative (0%, <25%, 25-50%, 50-75%, or >75%) hematoma growth scales. Results: In the development cohort, 22% (n=44) showed the spot sign, 34.5% (n=69) the hypodensity sign, and 7% (n=14) the B&W sign. Those with the B&W sign had higher proportions of HE (100% vs. 19.4%, p<0.001), greater absolute hematoma growth (23.37 mL [IQR=15.41-30.27] vs. 0 mL [IQR=0-2.39], p<0.001) and relative hematoma growth (120% [IQR=49-192] vs. 0% [0-15%], p<0.001) in comparison to those without. The B&W sign yielded a specificity of 100%, a PPV of 100%, and an accuracy of 82%. In the validation cohort, 25% (n=76) showed the spot sign, 39.1% (n=119) the hypodensity sign, and 9.5% (n=29) the B&W sign. Those with B&W signs had higher proportions of HE (79.3% vs. 30.2%, p<0.001), greater absolute hematoma growth (19.1 mL [IQR=6.4-40] vs. 0.8 mL [0-5.6], p<0.001), and relative hematoma growth (92% [IQR=16-151%] vs. 9% [0-34%], p<0.001) in comparison to those without. The B&W sign yielded a specificity of 97%, a PPV of 79%, and an accuracy of 71%. We found a consistent progressive improvement in predicting HE when hypodensity and spot signs are absent, individually present, both present but not co-localized, and co-localized (Figures 2-3). The inter-rater agreement was excellent (k=0.84) in the development cohort, with a uniform imaging protocol of NCCT immediately followed by CTA at a single center, and moderate (k=0.54) in the validation cohort at multiple centers. Conclusion: The Black-&-White sign is a robust predictor of hematoma expansion occurrence and hematoma expansion severity.
Pensato, Umberto
( Humanitas University
, Milan
, Italy
)
Banerjee, Ankur
( University of Calgary
, Calgary
, Alberta
, Canada
)
Kulkarni, Girish
( N1506
, Bangalore
, India
)
Menon, Bijoy
( University of Calgary
, Calgary
, Alberta
, Canada
)
Goyal, Mayank
( university of calgary
, Calgary
, Alberta
, Canada
)
Hill, Michael
( UNIVERSITY CALGARY
, Calgary
, Alberta
, Canada
)
Molina, Carlos
( HOSPITAL VALL D HEBRON
, Barcelona
, Spain
)
Demchuk, Andrew
( University of Calgary
, Calgary
, Alberta
, Canada
)
Horn, Mackenzie
( University of Calgary
, Calgary
, Alberta
, Canada
)
Teleg, Ericka
( Grand River Hospital
, Kitchener
, Ontario
, Canada
)
Al Sultan, Abdulaziz
( University of Calgary
, Calgary
, Alberta
, Canada
)
Kasickova Machova, Linda
( University of Calgary
, Calgary
, Alberta
, Canada
)
Ohara, Tomoyuki
( Kyoto Prefectural University of Med
, Kyoto
, Japan
)
Ojha, Piyush
( University of Calgary
, Calgary
, Alberta
, Canada
)
Marzoughi, Sina
( University of Calgary
, Calgary
, Alberta
, Canada
)
Author Disclosures:
Umberto Pensato:DO NOT have relevant financial relationships
| Ankur Banerjee:No Answer
| Girish Kulkarni:DO NOT have relevant financial relationships
| Bijoy Menon:DO have relevant financial relationships
;
Individual Stocks/Stock Options:Circle CVI:Active (exists now)
; Advisor:Boehringer Ingelheim:Past (completed)
| Mayank Goyal:DO have relevant financial relationships
;
Consultant:Medtronic:Active (exists now)
; Ownership Interest:Circle:Active (exists now)
; Research Funding (PI or named investigator):Cerenovus:Active (exists now)
; Research Funding (PI or named investigator):Medtronic:Active (exists now)
; Advisor:Fluid Biomed:Active (exists now)
; Consultant:Mentice:Active (exists now)
; Consultant:Microvention:Active (exists now)
| Michael Hill:DO have relevant financial relationships
;
Consultant:Brainsgate Inc:Past (completed)
; Individual Stocks/Stock Options:Circle Inc:Active (exists now)
; Individual Stocks/Stock Options:Basking Bioscience:Active (exists now)
; Research Funding (PI or named investigator):Boehringer-Ingelheim:Active (exists now)
; Research Funding (PI or named investigator):Medtronic:Active (exists now)
; Consultant:Diamedica Inc:Active (exists now)
| Carlos Molina:DO NOT have relevant financial relationships
| Yolanda Silva:DO NOT have relevant financial relationships
| jean-martin boulanger:DO NOT have relevant financial relationships
| Gord Gubitz:No Answer
| Rohit Bhatia:DO NOT have relevant financial relationships
| Koji Tanaka:DO NOT have relevant financial relationships
| PADMA SRIVASTAVA:DO NOT have relevant financial relationships
| Jayanta Roy:DO NOT have relevant financial relationships
| Imanuel Dzialowski:No Answer
| Carlos Kase:DO NOT have relevant financial relationships
| Adam Kobayashi:No Answer
| David Rodriguez-Luna:DO NOT have relevant financial relationships
| Richard Aviv:DO NOT have relevant financial relationships
| Dar Dowlatshahi:DO NOT have relevant financial relationships
| Andrew Demchuk:DO NOT have relevant financial relationships
| MacKenzie Horn:DO NOT have relevant financial relationships
| Ericka Teleg:DO NOT have relevant financial relationships
| Abdulaziz Al Sultan:DO NOT have relevant financial relationships
| Linda Kasickova Machova:DO NOT have relevant financial relationships
| Tomoyuki Ohara:DO NOT have relevant financial relationships
| Piyush Ojha:DO NOT have relevant financial relationships
| Sina Marzoughi:No Answer
