Abstract
Objectives: Hemorrhage expansion (HE) is a common and serious condition in patients with intracerebral hemorrhage (ICH). In contrast to the volume changes, little is known about the morphological changes that occur during HE. We developed a novel method to explore the patterns of morphological change and investigate the clinical significance of this change in ICH patients.Methods: The morphological changes in the hematomas of ICH patients with available paired non-contrast CT data were described in quantitative terms, including the diameters of each hematoma in three dimensions, the longitudinal axis type, the surface regularity (SR) index, the length and direction changes of the diameters, and the distance and direction of movement of the center of the hematoma. The patterns were explored by descriptive analysis and difference analysis in subgroups. We also established a prognostic nomogram model for poor outcomes in ICH patients using both morphological changes and clinical parameters.Results: A total of 1,094 eligible patients from four medical centers met the inclusion criteria. In 266 (24.3%) cases, the hematomas enlarged; the median absolute increase in volume was 14.0 [interquartile range (IQR), 17.9] mL. The initial hematomas tended to have a more irregular shape, reflected by a larger surface regularity index, than the developed hematomas. In subtentorial and deep supratentorial hematomas, the center moved in the direction of gravity. The distance of center movement and the length changes of the diameters were small, with median values of less than 4 mm. The most common longitudinal axis type was anterior–posterior (64.7%), and the axis type did not change between initial and repeat imaging in most patients (95.2%). A prognostic nomogram model including lateral expansion, a parameter of morphological change, showed good performance in predicting poor clinical outcomes in ICH patients.Conclusions: The present study provides a morphological perspective on HE using a novel automatic approach. We identified certain patterns of morphological change in HE, and we believe that some morphological change parameters could help physicians predict the prognosis of ICH patients.
Highlights
Spontaneous intracerebral hemorrhage produces mortality or disability in approximately 50% of cases [1, 2], imposing a severe burden [3, 4]
We developed and applied a novel approach to explore the patterns of morphological change during Hemorrhage expansion (HE), which provided a new perspective on hematoma expansion and might help physicians predict the prognosis of intracerebral hemorrhage (ICH) patients
All data were obtained from the Chinese Intracranial Hemorrhage Image Database (CICHID), which was initiated by Peking Union Medical College Hospital (PUMCH) in February 2019 and supported by the Group of Medical Data, Chinese Medical Doctor Association [16]
Summary
Spontaneous intracerebral hemorrhage (sICH) produces mortality or disability in approximately 50% of cases [1, 2], imposing a severe burden [3, 4]. Hemorrhage expansion (HE) occurs in approximately one-quarter of sICH patients [2, 5] and is a major determinant of deterioration and death [5,6,7]. It is important to explore the changes associated with HE [8, 9]. The patterns of morphological change have not been explored. Many studies have found that the initial shape of a hematoma was associated with the quality of outcomes [14, 15]. Few studies have focused on the relationship between morphological changes and patient prognosis
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