Hypodensities within hematoma is time dependent and predicts outcome after spontaneous intracerebral hemorrhage

Abstract

NCCT brain imaging biomarkers of hematoma expansion in ICH has gained relevance in recent times. Though the intra-hematoma hypodensities can predict hematoma expansion and outcome, it is postulated to be time dependent. To assess the differential prevalence of intra-hematoma hypodensity in spontaneous ICH over time from performance of NCCT from symptom onset and assess its predictive valve in early hematoma expansion and functional outcome at 3 months. Patients with ICH within 48 hours of stroke onset were included. Baseline clinical and demographic data was collected. Baseline NCCT Brain was analysed for hematoma volume, characterisation of intra-hematoma hypodensity, with 24 hour follow up NCCT hematoma volume calculated for identification of hematoma expansion. Poor functional outcome was defined as mRS> 3. 92 subjects were included in the study. Intra-hematoma hypodensity was found in 40%. Prevalence of intra-hematoma hypodensity was higher in those with baseline NCCT performed within 3 hours of symptom onset compared to those beyond 3 hours. 54% of patients with intra-hematoma hypodensity had hematoma expansion compared to 29% without (P = 0.02). Multivariate analysis revealed presence of intra-hematoma hypodensity (rather than pattern or number) to be strongly associated with poor functional outcome at 3 months (OR 3.86; 95% CI: 1.11 -13.42, P = 0.03). There is a decreasing prevalence of intra-hematoma hypodensity as time from symptom onset to NCCT increases. Nevertheless the presence of intra-hematoma hypodensity is significantly associated with hematoma expansion and predicted poor short term functional outcomes in spontaneous ICH.