Ultra-early computed tomography markers of haematoma expansion: Potential trial targets?
- Author(s)
- Mutimer, CA; Sharma, S; Zhao, H; Meretoja, A; Churilov, L; Wu, TY; Kleinig, TJ; Choi, PM; Cheung, A; Jeng, JS; Ma, H; Mai, DT; Nguyen, HT; Sharma, G; Campbell, BC; Donnan, GA; Davis, SM; Yassi, N;
- Abstract
- INTRODUCTION: The predictive value of CT markers of intracerebral haemorrhage (ICH) expansion is time-dependent, but data in the ultra-early period (<2 h from onset) are limited. We aimed to describe the frequency of these CT markers, their association with haematoma volume, haematoma expansion (HE) and functional outcome at 90-days. We also investigated the effect of tranexamic acid on HE in the presence of these markers. PATIENTS AND METHODS: We performed a pooled analysis of individual patient data from the STOP-AUST and STOP-MSU placebo-controlled randomised trials of tranexamic acid, including ICH patients scanned within 2 h of symptom onset. Logistic regression was used to assess the association between CT markers and HE or 90-days functional outcomes (poor outcome defined as mRS3-6). RESULTS: Among 246 patients, the swirl sign (74.3%) was the most frequent CT marker and the blend sign least frequent (7.3%). All markers were associated with increased baseline haematoma volume, and excluding the black hole sign, all were more common in patients with 24-h HE. The blend and spot signs were associated with 24-h HE and heterogenous density, swirl sign, hypodensity and island sign were associated with poor 90-day function outcomes in univariate logistic regression. However, the area under the receiver-operating-characteristic curve was similar for all markers and indicated low discriminative ability (Chi-squared test p = 0.81). A potential benefit of tranexamic acid in HE reduction was observed in patients with the spot sign (interaction p = 0.01)Conclusions:The discriminative utility of CT markers of HE in the early timeframe appears insufficient. There may be an effect of tranexamic acid in spot sign positive patients <2 h from onset.
- Keywords
- Intracerebral haemorrhage; computed tomography; haematoma expansion; prognosis
- PubMed ID
- 40650563
- Publisher's Version
- https://doi.org/10.1177/23969873251355938
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Creation Date: 2025-07-28 03:09:56
Last Modified: 2025-07-28 03:11:13