PT  - JOURNAL ARTICLE
AU  - Pensato, Umberto
AU  - Tanaka, Koji
AU  - Kaveeta, Chitapa
AU  - Ospel, Johanna
AU  - Horn, MacKenzie
AU  - Rodriguez-Luna, David
AU  - Singh, Nishita
AU  - Banerjee, Ankur
AU  - Wasyliw, Sanchea
AU  - Horn, Kennedy
AU  - Bobyn, Amy
AU  - Neweduk, Anneliese
AU  - Qiu, Wu
AU  - Goyal, Mayank
AU  - Menon, Bijoy
AU  - Demchuk, Andrew
TI  - Stepwise improvement in intracerebral haematoma expansion prediction with advanced imaging: a comprehensive comparison of existing scores
AID  - 10.1136/svn-2024-003988
DP  - 2025 Apr 07
TA  - Stroke and Vascular Neurology
PG  - svn-2024-003988
4099  - http://svn.bmj.com/content/early/2025/04/07/svn-2024-003988.short
4100  - http://svn.bmj.com/content/early/2025/04/07/svn-2024-003988.full
AB  - Background We aim to comprehensively assess and compare the predictive performance of haematoma expansion (HE) scores in a homogeneous cohort of acute intracerebral haemorrhage (ICH) patients.Methods Existing scores for predicting HE in acute ICH patients were included and categorised by imaging modality: non-contrast CT (NCCT), single-phase CT angiography (sCTA) and multiphase CTA (mCTA). The predictive performance of the scores was evaluated with the c-statistic in a population of consecutive adult patients with acute ICH admitted to a tertiary care centre in Southern Alberta, Canada, between February 2012 and May 2020, investigated with a multimodal imaging protocol (NCCT, sCTA and mCTA). The primary outcome was HE (ICH volume growth ≥6 mL or ≥33%), and the secondary outcome was severe HE (ICH volume growth ≥12.5 mL or ≥66%). The DeLong test compared the best-performing scores from each imaging category.Results 16 HE scores were assessed (NCCT=8, sCTA=6 and mCTA=2) in 217 patients with a median age of 70 years (IQR=60–80), and 86 (39.6%) were females. 51 (23.5%) patients experienced HE and 35 (16.1%) had severe HE. The c-statistic for predicting HE ranged from 0.516 to 0.674 for NCCT-based scores, 0.627 to 0.725 for sCTA-based scores and 0.800 to 0.814 for mCTA-based score. The c-statistic for predicting severe HE ranged from 0.505 to 0.666 for NCCT scores, 0.651 to 0.740 for sCTA scores and 0.813 to 0.828 for mCTA scores. A statistically significant difference favouring mCTA over other imaging modalities in predicting both HE and severe HE was observed.Conclusions Advanced imaging demonstrated a stepwise improvement in the predictive performance of HE scores. However, no existing score achieved excellent predictive performance (c-statistics ≥0.90) in our cohort, highlighting the need for further refinement.