Abstract
Intracerebral hemorrhage growth independently predicts disability and death. We hypothesized that noncontrast quantitative CT densitometry reflects active bleeding and improves predictive models of growth. We analyzed 81 of the 96 available baseline CT scans obtained <3 hours post-ICH from the placebo arm of the phase IIb trial of recombinant factor VIIa. Fifteen scans could not be analyzed for technical reasons, but baseline characteristics were not statistically significantly different. Hounsfield unit histograms for each ICH were generated. Analyzed qCTD parameters included the following: mean, SD, coefficient of variation, skewness (distribution asymmetry), and kurtosis ("peakedness" versus "flatness"). These densitometry parameters were examined in statistical models accounting for baseline volume and time-to-scan. The coefficient of variation of the ICH attenuation was the most significant individual predictor of hematoma growth (adjusted R(2) = 0.107, P = .002), superior to BV (adjusted R(2) = 0.08, P = .006) or TTS (adjusted R(2) = 0.03, P = .05). The most significant combined model incorporated coefficient of variation, BV, and TTS (adjusted R(2) = 0.202, P = .009 for coefficient of variation) compared with BV and TTS alone (adjusted R(2) = 0.115, P < .05). qCTD increased the number of growth predictions within ±1 mL of actual 24-hour growth by up to 47%. Heterogeneous ICH attenuation on hyperacute (<3 hours) CT imaging is predictive of subsequent hematoma expansion and may reflect an active bleeding process. Further studies are required to determine whether qCTD can be incorporated into standard imaging protocols for predicting ICH growth.
Highlights
MethodsWe analyzed 81 of the 96 available baseline CT scans obtained Ͻ3 hours post-ICH from the placebo arm of the phase IIb trial of recombinant factor VIIa. Fifteen scans could not be analyzed for technical reasons, but baseline characteristics were not statistically significantly different
BACKGROUND AND PURPOSEIntracerebral hemorrhage growth independently predicts disability and death
Heterogeneous ICH attenuation on hyperacute (Ͻ3 hours) CT imaging is predictive of subsequent hematoma expansion and may reflect an active bleeding process
Summary
We analyzed 81 of the 96 available baseline CT scans obtained Ͻ3 hours post-ICH from the placebo arm of the phase IIb trial of recombinant factor VIIa. Fifteen scans could not be analyzed for technical reasons, but baseline characteristics were not statistically significantly different. Analyzed qCTD parameters included the following: mean, SD, coefficient of variation, skewness (distribution asymmetry), and kurtosis (“peakedness” versus “flatness”). These densitometry parameters were examined in statistical models accounting for baseline volume and time-to-scan. The dataset used was the baseline CT scans from the placebo group of the proof-of-concept trial of rFVIIa.[2] Briefly, this randomized, double-blind, placebo-controlled trial involved 399 patients with spontaneous ICH, diagnosed by baseline CT within 3 hours of onset, who were randomized to placebo (n ϭ 96) or 1 of 3 dose regimens of rFVIIa. Of the 96 placebo patients, 81 were available for analysis. Detailed methodology and reliability studies of imaging analysis in this trial have been published demonstrating within and between-rater intraclass correlation coefficients of Ͼ0.95.15
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