Abstract W MP112: Hematoma Contraction In Primary Intracerebral Hemorrhage Is Associated With Short-term Functional Outcome

Abstract

Introduction: Although blood clot retraction is a normal part of wound healing, this process has never been documented in intracerebral hemorrhage (ICH). Using a serial imaging approach, we aimed to assess the frequency of hematoma contraction in ICH patients. We also tested the hypothesis that hematoma contraction is associated with increased perihematoma edema volumes. Methods: We conducted a retrospective imaging study in primary ICH patients with a non-contrast CT (NCCT) study within 24h of symptom onset. All patients had a follow-up NCCT within 48h of the baseline scan. Patients who underwent any surgical intervention were excluded. Two blinded assessors, planimetrically measured hematoma and perihematoma edema volumes. Hematoma contraction was defined a priori as ≥10% reduction in ICH volume from baseline. Results: A total of 202 patients with a mean±SD age of 67.9±15.1 years were included. The mean baseline ICH volume was 22.5±23.8ml. The mean difference in ICH volume between the two raters was 0.2±0.8ml (Intraclass correlation coefficient-0.93; 95% Limits of Agreement=0.82-0.95). Hematoma contraction of at least 10% from baseline was seen in 22 (10.9%) patients. The mean absolute change in volume in these patients was -3.9±4.2ml. Hematoma expansion occurred in 51 (25.2%) patients. There is no difference in mean interscan interval between patients with ICH contraction (26.1±11.7h), expansion (20.7±11.8h) or stability (24.2±10.6h, p=0.96). Baseline perihematoma edema volumes were larger in patients with subsequent hematoma contraction (8.9±9.7ml) than those with stable (2.6±2.8 ml) or expanding ICH (3.5±4.4 ml, p<0.0001). Perihematoma edema volume growth was greater in patients with hematoma expansion (7.8±12.11ml) than those with contracting (3.4±4.7ml), or stable ICH (1.6±3.2ml, p=0.004). Median (IQR) modified Rankin scale scores were lower in patients with hematoma contraction (3(2)) or stable hematomas (3(3)) than those with expansion (6(2), p<0.0001). Conclusions: Hematoma contraction is evident in approximately 10% of ICH patients. Baseline perihematoma edema volume in patients with subsequent hematoma contraction is larger, which is consistent with the hypothesis that acute edema represents successful hemostasis.