THE OUTCOME PREDICTION USING NON-CONTRAST COMPUTED TOMOGRAPHY SCAN AND COMPUTED TOMOGRAPHY ANGIOGRAPHY SCAN IN ACUTE HEMORRHAGIC STROKE

Authors

  • Yasir Hamdy Rauf High Diploma Student, Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Sarwer Jamal Al-Bajalan Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Mohamad Tahir Kurmanji Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10314

Keywords:

Blackhole sign, Blend sign, Intracerebral haemorrhage (ICH), Intracerebral haemorrhage (ICH) score, Island sign, Spot sign, Swirl sign

Abstract

Background 

Intracerebral haemorrhage (ICH) outcome depends on hematoma volume, location, and expansion.

Objectives 

To assess the validity of neuroimaging signs for predicting the prognosis of patients with acute ICH in our population.

Patients and Methods

A prospective cohort study was performed on 90 patients with acute ICH admitted to Shar Hospital from March to October 2019. Inclusion criteria were ages of ≥18 years and spontaneous ICH, and exclusion criteria were trauma, brain tumour, and secondary ICH. Demographic features were recorded. Blackhole, swirl, island, Blend and spot signs, ICH location and volume, and ICH score were assessed by non-contrast computed tomography (CT) scan and CT angiography. Glasgow coma scale (GCS) and modified Rankin scale were used to assessing patients’ outcomes

Results

Except for the ages of patients (p-values=0.01), other demographic characteristics had no significant associations with the expansion of hematoma and outcome. Modified Rankin Scale, GCS, and hematoma location and volume had statistically significant associations with hematoma expansion and outcome. Further, strong sensitivity of black hole (90.9%) and spot (92.8%) signs, strong specificity of Blend (92.6%) and spot signs (97.1%), substantial positive predictive value for spot sign (92.8%), substantial negative predictive value was for all signs. In addition, substantial accuracy of spot sign (95.8%), were found. Also, significant associations for all the signs, except Blend, with hematoma expansion were found. 

Conclusion

It is better to use neuroimaging signs, at least the signs found on non-contrast CT scans, all together in clinical practice.

References

Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean stroke society and clinical research centre for stroke. J Stroke. 2013; 15(1):2–20. DOI: https://doi.org/10.5853/jos.2013.15.1.2

Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum.J Neurol Neurosurg Psychiatry. 2012; 83(2):124–37. DOI: https://doi.org/10.1136/jnnp-2011-301308

Rost NS, Greenberg SM, Rosand J. The genetic architecture of intracerebral haemorrhage. Stroke. 2008(7); 39:2166–73. DOI: https://doi.org/10.1161/STROKEAHA.107.501650

An SJ, Kim TJ, Yoon BW. Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update. J Stroke. 2017; 19(1):3-10. DOI: https://doi.org/10.5853/jos.2016.00864

Jolink WM, Klijn CJ, Brouwers PJ, Kappelle LJ, Vaartjes I. Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology. 2015; 85(15):1318–24. DOI: https://doi.org/10.1212/WNL.0000000000002015

Stein M, Misselwitz B, Hamann GF, Scharbrodt W, Schummer DI, Oertel MF. Intracerebral haemorrhage in the very old: future demographic trends of an ageing population. Stroke. 2012; 43(4):1126–8. DOI: https://doi.org/10.1161/STROKEAHA.111.644716

Liotta EM, Prabhakaran S. Warfarin-associated intracerebral haemorrhage is increasing in prevalence in the United States. J Stroke Cerebrovasc Dis. 2013; 22(7):1151–5. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.11.015

Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012; 11(8):720–31. DOI: https://doi.org/10.1016/S1474-4422(12)70104-7

Manno EM, Atkinson JL, Fulgham JR, Wijdicks EF. Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral haemorrhage. Mayo Clin Proc. 2005; 80(3):420–33. DOI: https://doi.org/10.4065/80.3.420

Qureshi AI, Suri MF, Ostrow PT, Kim SH, Ali Z, Shatla AA, et al. Apoptosis as a form of cell death in intracerebral haemorrhage. Neurosurgery. 2003; 52(5):1041–7. DOI: https://doi.org/10.1227/01.NEU.0000057694.96978.BC

Graham DI, McIntosh TK, Maxwell WL, Nicoll JA. Recent advances in neurotrauma. J Neuropathol Exp Neurol. 2000; 59(8):641–51. DOI: https://doi.org/10.1093/jnen/59.8.641

Xi G, Reiser G, Keep RF. The role of thrombin and thrombin receptors in ischemic, hemorrhagic and traumatic brain injury: deleterious or protective? J Neurochem. 2003; 84(1):3–9. DOI: https://doi.org/10.1046/j.1471-4159.2003.01268.x

Sturgeon JD, Folsom AR, Longstreth WT Jr, Shahar E, Rosamond WD, Cushman M. Risk factors for intracerebral haemorrhage in a pooled prospective study. Stroke. 2007; 38(10):2718–25. DOI: https://doi.org/10.1161/STROKEAHA.107.487090

O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735):112–23. DOI: https://doi.org/10.1016/S0140-6736(10)60834-3

Chan S, Hemphill JC. Critical care management of intracerebral haemorrhage. Crit Care Clin. 2014; 30(4):699–717. DOI: https://doi.org/10.1016/j.ccc.2014.06.003

European Stroke Initiative Writing C, Writing Committee for the EEC, Steiner T, Kaste M, Forsting M, Mendelow D, et al. Recommendations for managing intracranial haemorrhage - part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006; 22(4):294-316.

Vespa PM, O'Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, et al. Acute seizures after intracerebral haemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003; 60(9):1441–6. DOI: https://doi.org/10.1212/01.WNL.0000063316.47591.B4

Fang MC, Go AS, Chang Y, Hylek EM, Henault LE, Jensvold NG, et al. Death and disability from warfarin-associated intracranial and extracranial haemorrhages. Am J Med. 2007; 120(8):700–5. DOI: https://doi.org/10.1016/j.amjmed.2006.07.034

Divani AA, Majidi S, Luo X. The ABCs of accurate volumetric measurement of cerebral hematoma. Stroke. 2011; 42(6):1569–74. DOI: https://doi.org/10.1161/STROKEAHA.110.607861

Hemphill JC III, Greenberg SM, Anderson CS. Guidelines for the management of spontaneous intracerebral haemorrhage. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015; 46(7):2032–60. DOI: https://doi.org/10.1161/STR.0000000000000069

Miyagi T, Koga M, Yamagami H, Okuda S, Okada Y, Kimura K, et al. Reduced estimated glomerular filtration rate affects outcomes three months after intracerebral haemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral haemorrhage study. J Stroke Cerebrovasc Dis. 2015; 24(1):176–82. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.08.015

Orito K, Hirohata M, Nakamura Y, Takeshige N, Aoki T, Hattori G, et al. Leakage sign for primary intracerebral haemorrhage: a novel predictor of hematoma growth. Stroke. 2016; 47(4):958–63. DOI: https://doi.org/10.1161/STROKEAHA.115.011578

Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M, et al. Prehospital neurologic deterioration in patients with intracerebral haemorrhage. Crit Care Med. 2008; 36(1):172–5. DOI: https://doi.org/10.1097/01.CCM.0000297876.62464.6B

Smith EE, Rosand J, Greenberg SM. Hemorrhagic stroke. Neuroimaging Clin N Am. 2005; 15(2):259–72. DOI: https://doi.org/10.1016/j.nic.2005.05.003

Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol. 2017; 2(1):21-9. DOI: https://doi.org/10.1136/svn-2016-000047

Delgado Almandoz JE, Yoo AJ, Stone MJ. Systematic characterization of the computed tomography angiography spot sign in primary intracerebral haemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score. Stroke. 2009; 40(9):2994–3000. DOI: https://doi.org/10.1161/STROKEAHA.109.554667

Douglas V, Shamy M, Bhattacharya P. Should CT Angiography be a Routine Component of Acute Stroke Imaging? Neurohospitalist. 2015; 5(3):97-8. DOI: https://doi.org/10.1177/1941874415588393

Kim J, Smith A, Hemphill JC, Smith WS, Lu Y, Dillon WP, et al. Contrast extravasation on CT predicts mortality in primary intracerebral haemorrhage. AJNR Am J Neuroradiol. 2008; 29(3):520–5. DOI: https://doi.org/10.3174/ajnr.A0859

Al-Nakshabandi NA. The swirl sign. Radiology. 2001; 218(2):433. DOI: https://doi.org/10.1148/radiology.218.2.r01fe09433

Li Q, Zhang G, Xiong X, Wang X-C, Yang W-S, Li K-W, et al. Black Hole Sign: Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage. Stroke J Cereb Circ. 2016; 47(7):1777–81. DOI: https://doi.org/10.1161/STROKEAHA.116.013186

Li Q, Zhang G, Huang Y-J, Dong M-X, Lv F-J, Wei X, et al. Blend Sign on Computed Tomography: Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage. Stroke. 2015; 46(8):2119–23. DOI: https://doi.org/10.1161/STROKEAHA.115.009185

Li Q, Liu QJ, Yang WS, Wang XC, Zhao LB, Xiong X, et al. Island Sign: An Imaging Predictor for Early Hematoma Expansion and Poor Outcome in Patients With Intracerebral Hemorrhage. Stroke. 2017; 48(11):3019-25. DOI: https://doi.org/10.1161/STROKEAHA.117.017985

Shulman JG, Jara H, Qureshi MM, Lau H, Finn B, Abbas S, et al. Perihematomal oedema surrounding spontaneous intracerebral haemorrhage by CT: Ellipsoidal versus morphometric volumetry. Medicine (Baltimore). 2020; 99(28):e20951. DOI: https://doi.org/10.1097/MD.0000000000020951

Krishnamurthi RV, Moran AE, Forouzanfar MH, Bennett DA, Mensah GA, Lawes CM, et al. The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study. Glob Heart. 2014; 9(1):101–6. DOI: https://doi.org/10.1016/j.gheart.2014.01.003

Sporns PB, Kremmling A, Schwake M, Minnerup J, Nawabi J, Broocks G, et al. Triage of 5 Noncontrast Computed Tomography Markers and Spot Sign for Outcome Prediction After Intracerebral Hemorrhage. Stroke. 2018; 49(10):2317-22. DOI: https://doi.org/10.1161/STROKEAHA.118.021625

Boehme AK, Esenwa C, Elkind MS. Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017; 120(3):472-495. DOI: https://doi.org/10.1161/CIRCRESAHA.116.308398

World Health Organization. Global Health Estimates: Life expectancy and leading causes of death and disability [Internet]. Life expectancy; 2019 [cited 2020 August 28]. Available from: https://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/.

Huynh TJ, Symons SP, Aviv RI. Advances in CT for prediction of hematoma expansion in acute intracerebral haemorrhage. Imaging Med. 2013; 5(6):539–51. DOI: https://doi.org/10.2217/iim.13.64

Published

2021-09-21

How to Cite

1.
Rauf Y, Al-Bajalan S, Kurmanji M. THE OUTCOME PREDICTION USING NON-CONTRAST COMPUTED TOMOGRAPHY SCAN AND COMPUTED TOMOGRAPHY ANGIOGRAPHY SCAN IN ACUTE HEMORRHAGIC STROKE. JSMC [Internet]. 2021 Sep. 21 [cited 2024 Apr. 23];11(3):297-30. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10314

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