Once again you know of and describe the problem, BUT DO NOTHING TO SOLVE IT! You're fired!
Non-contrast CT Markers of Intracerebral Hemorrhage Expansion: The influence of onset-to-CT time
Abstract
Background:
Hematoma expansion (HE) is an appealing therapeutic target in
intracerebral hemorrhage (ICH) and non-contrast computed tomography
(NCCT) features are promising predictors of HE.
Aims:
We investigated whether onset-to-CT time influences the diagnostic performance of NCCT markers for HE.
Methods:
retrospective multicentre analysis of patients with primary ICH. The
following NCCT markers were analyzed: hypodensities, heterogeneous
density, blend sign, and irregular shape. HE was defined as growth > 6
mL and/or > 33%. We calculated the sensitivity, specificity,
positive and negative predictive values (PPV and NPV) of NCCT markers
for HE, stratified by onset-to-CT time (< 2 h, 2-4 h, 4-6 h, >6
h).
Results:
We included 1135 patients, (median age 69, 53% males) of whom 307 (27%) experienced HE.
Overall
hypodensities had the highest sensitivity (0.68) and blend sign the
highest specificity (0.87) for HE. Hypodensities were more common and
had higher sensitivity (0.80) in patients with imaging within 2 h. The
same result was observed for heterogeneous density whereas irregular
shape had a similar prevalence across time strata and higher sensitivity
(0.79) beyond 6 h from onset. The frequency of blend sign increased
with longer onset-to-CT-time whereas its specificity declined after 6 h
from onset.
Conclusion:
the diagnostic
performance of NCCT markers is influenced by imaging time. Hypodensities
identified four out of five patients with HE within 2 h from onset
whereas irregular shape performed better in late presenters. Our
findings may improve the use of NCCT markers in future studies and
trials targeting HE.
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