CT estimation of hematoma volume as a predictor of morbidity and mortality in patients with intracerebral hemorrhage

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CT estimation of hematoma volume as a predictor of
morbidity and mortality in patients with intracerebral
hemorrhage
Poster No.: C-2276
Congress: ECR 2015
Type: Scientific Exhibit
Authors: A. Z. Aracki-Trenkic, D. A. Stojanov, S. Lukic, S. Stankovic; Nis/RS
Keywords: CNS, CT, Diagnostic procedure, Haemorrhage
DOI: 10.1594/ecr2015/C-2276
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Aims and objectives
CT is the imaging technique of choice to detect early intracerebral hemorrhage (ICH) with
potential to provide quantitative hematoma data and implications for use as a predictor
of clinical outcome. ICH is a non-traumatic hemorrhage from parenchymal blood vessels
of the brain, which can spread to the ventricles (intraventricular haemorrhage, IVH)
and subarachnoid space (subarachnoid hemorrhage, SAH). It represents the second
most common form of stroke, occurring in 10-30% of all stroke insults and it is one of
the major causes of morbidity and mortality, whereas in survivors it leads to significant
disability. About 30-50% of patients with ICH die within 30 days of haemorrhage onset,
about half of these deaths occur within the first 48 hours. The most common conditions
that lead to the occurrence of ICH are arterial hypertension and cerebral amyloid
angiopathy (CAA). These hematomas are primary ICH. Secondary hematomas occur
as a consequence of vascular malformations, tumors, etc. On the basis of localization,
intracerebral hemorrhages are categorized as deep, lobar, cerebellar and pontine (Fig.1).
The most important predictors of outcome after an ICH include ICH volume, Glasgow
Coma Scale Score (GCSS), preasence of IVH, and age.
We aimed to evaluate the significance of hematoma volume, location, ventricular
extension and clinical findings in prediction of morbidity and mortality in patients with
acute ICH.
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Images for this section:
Fig. 1: ICH localization: a)deep, b)lobar, c)cerebellar, d)pontine
© Center for Radiology, Clinical Center Nis - Nis/RS
Page 3 of 13

Methods and materials
A single center retrospective study included 40 patients, mean age 77.5 years, 22 (55%)
female and 18 (45%) male, with ICH. Patients with traumatic ICH, hemorrhage caused by
tumors, SAH as well as hemorrhagic transformation of cerebral infarction were excluded
from the study. In all patients, the period from the onset of symptoms to the initial CT
scan was less than 24 hours. All patients underwent unenhanced CT scan at the Center
for Radiology, Clinical Center of Nis, on MSCT performed by General Electric Bright
speed scanner with a slice thickness of 5 mm in supratentorial regions and 2.5 mm in the
infratentorial fossa and Toshiba Aquilion with a slice thickness of 3 mm of the hole brains.
We analyzed hematoma volume, location and ventricular extension. The hematoma
volume was estimated by the elliptical approximation method ABC/2, where A is defined
as the largest axial diameter evident in any slice, B as the largest axial diameter
perpendicular to A, and C represents the vertical diameter (the product of slice thickness
and the number of slices in which the hemorrhage is visible) (Fig.2). Then, we did a
comparison with clinical and laboratory parameters, obtained by reviewing the medical
history of the patients. Neurological function at presentation was assessed by GCSS.
Test results were statistically processed and analyzed using Wald test of maximum
likelihood (Wald test) and linear regression analysis. The values for p <0.05 were
considered statistically significant.
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Images for this section:
Fig. 2: Measurement of ICH volume
© Center for Radiology, Clinical Center Nis - Nis/RS
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Results
Twelve (30%) patients died within the first 3 days after admission. The volume of
hematoma was significantly higher in deceased patients [49.7 (10.08-104.16) vs. 9.65
(4.65-27.23) cm3; p<0.05]. There was a statistically significant correlation between
mortality and hematoma volume # 30 cm3 (p<0.05) (Tab.1). The risk of a lethal outcome
is 6.75 times higher for patients with a GCSS of 3-8 (Fig.3), and 4.6 times for patients
with IVH (Tab.2).
The results also show that the values of arterial pressure cannot be considered as
significant predictors of patients' outcome (Fig.4).
Considering the localization, the largest number of patients with a lethal outcome had a
lobar hemorrhage (58.3%), whereas in a slightly smaller number of patients there was a
deep localization of hemorrhage (Tab.2).
There was no statistically significant correlation between age and a lethal outcome
(Fig.5), as well as between sex and a lethal outcome, although the odds ratio for the
occurrence of a possible lethal outcome is 2.16 times higher in men (Fig.6).
The volume of hematoma (p<0.05), presence of IVH (p<0.05), and initial GCSS (p<0.05)
were significant predictors of mortality, whereas age, sex, systolic blood pressure, and
location of hemorrhage were not.
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Images for this section:
Table 1: Radiological features-volume: a statistically significant correlation between
mortality and hematoma volume # 30 cm3; IQR-interquartile range
© Center for Radiology, Clinical Center Nis - Nis/RS
Fig. 3: Values of GCSS in groups with a different outcome: the risk of a lethal outcome
is 6.75 times higher for patients with a GCSS (3-8).
© Center for Radiology, Clinical Center Nis - Nis/RS
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Table 2: Radiological features-localization: the risk of a lethal outcome is 4.6 times higher
for patients with IVH
© Center for Radiology, Clinical Center Nis - Nis/RS
Fig. 4: The values of arterial pressure (AP) parameters in groups with a different outcome.
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© Center for Radiology, Clinical Center Nis - Nis/RS
Fig. 5: Age distribution of patients in groups with a different outcome
© Center for Radiology, Clinical Center Nis - Nis/RS
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Fig. 6: Gender distribution of patients in groups with a different outcome
© Center for Radiology, Clinical Center Nis - Nis/RS
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Conclusion
Hematoma volume greater than 30 cm3, a low GCSS (3-8) and the presence of IVH
are significant predictors of a high mortality rate. CT measuring of hematoma volume is
powerful and easy-to-use predictor of clinical outcome in patients with ICH.
Page 11 of 13

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