Abstract
BackgroundFollow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth. This study assesses the volumetric accuracy of different imaging modalities (MRI, CT angiography, postcontrast CT) to measure hematoma size.Methods28 patients with acute spontaneous intracerebral hemorrhage referred to a tertiary stroke center were retrospectively included between 2018 and 2019. Inclusion criteria were (1) spontaneous intracerebral hemorrhage (supra- or infratentorial), (2) noncontrast CT imaging performed on admission, (3) follow-up imaging (CT angiography, postcontrast CT, MRI), and (4) absence of hematoma expansion confirmed by a third cranial image within 6 days. Two independent raters manually measured hematoma volume by drawing a region of interest on axial slices of admission noncontrast CT scans as well as on follow-up imaging (CT angiography, postcontrast CT, MRI) using a semi-automated segmentation tool (Visage image viewer; version 7.1.10). Results were compared using Bland–Altman plots.ResultsMean admission hematoma volume was 18.79 ± 19.86 cc. All interrater and intrarater intraclass correlation coefficients were excellent (1; IQR 0.98–1.00). In comparison to hematoma volume on admission noncontrast CT volumetric measurements were most accurate in patients who received postcontrast CT (bias of − 2.47%, SD 4.67: n = 10), while CT angiography often underestimated hemorrhage volumes (bias of 31.91%, SD 45.54; n = 20). In MRI sequences intracerebral hemorrhage volumes were overestimated in T2* (bias of − 64.37%, SD 21.65; n = 10). FLAIR (bias of 6.05%, SD 35.45; n = 13) and DWI (bias of-14.6%, SD 31.93; n = 12) over- and underestimated hemorrhagic volumes.ConclusionsVolumetric measurements were most accurate in postcontrast CT while CT angiography and MRI sequences often substantially over- or underestimated hemorrhage volumes.
Highlights
Follow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth
Duration from initial non-contrast Computed Tomography (NCCT) to first follow-up imaging was a median of 16 h (IQR 1–28 h); to second follow-up imaging a median of 59 h (IQR 23–98 h)
We found an excellent correlation of hemorrhage volume measured on postcontrast Computed tomography (CT) in comparison to admission NCCT, while hematoma size on CTA was underestimated in some cases
Summary
Follow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth. This study assesses the volumetric accuracy of different imaging modalities (MRI, CT angiography, postcontrast CT) to measure hematoma size. Neuroradiologists rely on a different imaging modality for hematoma measurement with intermodal comparison to NCCT admission imaging [4]. The accuracy of such intermodal hematoma measurement is not known. CTA has become an integral part of the diagnostic workup because of its high sensitivity for vascular pathologies. The CTA spot sign, caused by an active extravasation of contrast agent, has been shown to be an indicator of hematoma expansion [6]. CTA is often followed by postcontrast CT to address the presence of underlying neoplastic disease [2]
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