Temporal evolution of non-contrast CT markers of expansion relates to the dynamics of acute intracerebral hemorrhage

Purpose: The temporal evolution of non-contrast CT (NCCT) markers of intracerebral hemorrhage (ICH) expansion during the dynamics of acute ICH is understudied. We aimed to evaluate the temporal evolution of these markers and its relationship with ICH dynamics. Methods: Single-center, prospective, observational cohort study on 271 ICH patients < 6 h. Patients underwent baseline NCCT and multiphase CTA, and 24-hour NCCT. NCCT markers included: irregular shape, satellite sign, and island sign (shape markers); heterogeneous density, hypodensities, swirl sign, black hole sign, blend sign, and fluid level (qualitative density markers); and mean, standard deviation, and coefficient of variation hematoma density (quantitative density markers). The spot sign in first phase of multiphase CTA was considered marker of active hemorrhage. Primary outcome was the change in frequency or values of NCCT markers from baseline to follow-up NCCT. Other outcomes included associations of active hemorrhage with NCCT markers at baseline and with the magnitude of their change at follow-up NCCT. Results: Heterogeneous density predicted active hemorrhage with the highest accuracy (66.4%); hypodensities had the highest AUC (0.626, 95% CI 0.561–0.691). From baseline to follow-up NCCT, the frequency of heterogeneous density (54 [27.8%] vs. 24 [12.4%], p < 0.001) and hypodensities (82 [42.3%] vs. 52 [26.8%], p < 0.001) decreased, with greater reductions when active hemorrhage at baseline (17 [29.0%] vs. 12 [10.0%], p = 0.001; and 15 [26.3%] vs. 13 [10.8%], p = 0.008; respectively). Conclusion: Heterogeneous density and hypodensities are the markers most closely related to acute ICH dynamics, better predicting active hemorrhage at baseline and decreasing with hematoma stabilization.