Article Figures & Data
Figures
- Figure 1
Flow chart of literature review and reasons for exclusion. Sixteen scores were derived from the final 14 studies. *Included the Spot Sign Score, 9-Point, BRAIN, PREDICT A/B (Prediction of Haematoma Growth and Outcome in Patients With Intracerebral Haemorrhage Using the CT-Angiography Spot Sign), HEP (Haematoma Expansion Prediction), Acute ICH Growth Score, HEAVN, BAT, Basal Ganglia Score and NAG Score. BAT, Blend sign, Any hypodensity, Time; HEAVN, Heterogeneity, peripheral Oedema, Anticoagulant use, Volume, Niveau formation; ICH, intracerebral haemorrhage; NAG, NIHSS, Anticoagulation, Glucose; NIHSS, National Institutes of Health Stroke Scale.
- Figure 2
The heatmap compares the performance (measured as c-statistics) of various predictive scores for intracerebral haematoma expansion (≥6 mL or ≥33%) grouped by imaging modality, including non-contrast CT (NCCT), single-phase CT angiography (sCTA) and multiphase CT angiography (mCTA). The colour gradient highlights the relative differences in performance, with darker colour indicating high c-statistics.
Tables
- Table 1
Patient characteristics
Acute ICH patients (n=217) Demographics Age (years) (median, IQR) 70 (60–80) Sex (F) (n, %) 86 (39.6) Medical History Diabetes (n, %) 41 (18.9) Arterial hypertension (n, %) 175 (80.7) Previous ischaemic stroke (n, %) 16 (7.4) Previous haemorrhagic stroke (n, %) 5 (2.3) Prior anticoagulants use 37 (18.0) Baseline clinical and radiological features NIHSS (median, IQR) 10 (5–20) GCS (median, IQR) 15 (11–15) Initial ICH volume (mL) (median, IQR) 18.9 (5.5–34.2) Known onset time (n, %) 103 (47.5) Onset-to-imaging time (min) (median, IQR) 225 (109–392) uHG (mL/h) (median, IQR) 4.4 (1.3–12.2) ICH location deep (n, %) 116 (53.5) Radiological markers of expansion Spot Sign (n, %) 69 (31.8) Hypodensity sign (n, %) 74 (34.1) Blend sign (n, %) 32 (14.8) Black hole (n, %) 27 (12.4) Island sign (n, %) 54 (24.9) Radiological outcomes Significant HE (≥6 mL or≥33%) 51 (23.5) Severe HE (≥12.5 mL or≥66%) 35 (16.1) Absolute HE (mL) (median, IQR) 0.2 (0–4.5) Relative HE (%) (median, IQR) 2% (0–19) Follow-up ICH volume 20.1 (6.4–43.5) GCS, Glasgow Coma Scale; HE, haematoma expansion; ICH, intracerebral haematoma; NIHSS, National Institutes of Health Stroke Scale; uHG, ultra-early haematoma growth.
- Table 2
Discrimination of non-contrast CT (NCCT) Scores to predict haematoma expansion
Haematoma expansion prediction Severe haematoma expansion prediction AUC (95% CI) AIC BIC Brier Score AUC (95% CI) AIC BIC Brier Score BAT Score 0.605 (0.525 to 0.686) 235.11 241.87 0.176 0.594 (0.500 to 0.689) 192.37 199.13 0.133 BRAIN Score 0.516 (0.430 to 0.603) 240.47 247.23 0.180 0.505 (0.404 to 0.605) 195.72 202.48 0.135 Basal Ganglia Score 0.612 (0.533 to 0.691) 236.65 243.41 0.177 0.569 (0.473 to 0.665) 194.67 201.43 0.135 NAG Score 0.522 (0.455 to 0.582) 240.28 247.04 0.180 0.544 (0.466 to 0.623) 194.79 201.55 0.135 HEAVN Score 0.674 (0.589 to 0.760) 225.50 232.26 0.167 0.654 (0.554 to 0.754) 186.33 193.09 0.129 NCCT Expansion Score 0.647 (0.589 to 0.760) 228.72 235.48 0.170 0.666 (0.570 to 761) 184.15 190.91 0.128 ‘Li et al22 NCCT Score’ 0.649 (0.565 to 0.733) 230.44 237.21 0.171 0.623 (0.523 to 0.723) 190.43 197.20 0.132 ‘Kong et al23 NCCT Score’ 0.602 (0.517 to 0.687) 234.69 241.45 0.175 0.601 (0.501 to 0.700) 191.69 198.45 0.133 AIC, Akaike information criterion; AUC, area under the curve; BAT, Blend sign, Any hypodensity, Time; BIC, Bayesian information criterion; HEAVN, Heterogeneity, peripheral Oedema, Anticoagulant use, Volume, Niveau formation; NAG, NIHSS, Anticoagulation, Glucose; NIHSS, National Institutes of Health Stroke Scale.
- Table 3
Discrimination of sCTA scores to predict haematoma expansion
Haematoma expansion prediction Severe haematoma expansion prediction AUC (95% CI) AIC BIC Brier Score AUC (95% CI) AIC BIC Brier Score ‘Applied to sCTA-Spot Sign Score’ 0.725 (0.650 to 0.800) 200.84 207.6 0.143 0.738 (0.649 to 0.826) 164.69 171.45 0.111 9-Point Score 0.717
(0.630 to 0.803)216.86 223.62 0.158 0.726 (0.629 to 0.823) 176.53 183.29 0.122 PREDICT-A Score 0.637 (0.548 to 0.726) 230.21 236.97 0.170 0.653 (0.552 to 0.755) 186.38 193.14 0.129 PREDICT-B Score 0.627 (0.533 to 0.721) 231.61 238.37 0.171 0.651 (0.545 to 0.756) 187.12 193.88 0.129 Acute ICH Growth Score 0.688 (0.604 to 0.771) 222.93 229.69 0.165 0.678 (0.573 to 0.778) 182.64 189.40 0.126 sCTA Expansion Score 0.720 (0.634 to 0.805) 207.29 214.05 0.148 0.740 (0643 to 0.837) 167.39 174.15 0.114 AIC, Akaike information criterion; AUC, area under the curve; BIC, Bayesian information criterion; ICH, intracerebral haematoma; sCTA, single-phase CT angiography.
- Table 4
Discrimination of mCTA Scores to predict haematoma expansion
Haematoma expansion prediction Severe haematoma expansion prediction AUC (95% CI) AIC BIC Brier Score AUC (95% CI) AIC BIC Brier Score ‘Applied to mCTA-Spot Sign Score’ 0.814 (0.746 to 0.882) 178.07 184.84 0.125 0.828
(0.753 to 0.903)147.21 153.97 0.101 mCTA Expansion Score 0.800
(0.732 to 0.868)184.37 191.13 0.131 0.813 (0.740 to 0.887) 161.31 158.07 0.106 AIC, Akaike information criterion; AUC, area under the curve; BIC, Bayesian information criterion; mCTA, multiphase CT angiography.
- Table 5
Results of the DeLong test for pairwise comparison of c-statistics of the best performing score for each imaging category
Prediction of HE Prediction of severe HE Difference in c-statistics Z-statistic P value Difference in c-statistics Z-statistics P value sCTA vs NCCT 0.05 1.039 0.299 0.07 1.319 0.187 mCTA vs sCTA 0.09 2.990 0.003 0.09 2.492 0.013 mCTA vs NCCT 0.14 2.724 0.006 0.16 3.233 0.001 NCCT scores used in the analyses were the HEAVN score for HE and the NCCT Expansion Score for severe HE.
HE, haematoma expansion; HEAVN, Heterogeneity, peripheral Oedema, Anticoagulant use, Volume, Niveau formation; mCTA, multiphase CT angiography; NCCT, non-contrast CT; sCTA, single-phase CT angiography.
Supplementary data
