Derivation and validation of three intracerebral hemorrhage expansion scores using different CT modalities

Objectives: To derivate and validate three scores for the prediction of intracerebral hemorrhage (ICH) expansion depending on the use of non-contrast CT (NCCT), single-phase CTA, or multiphase CTA markers of hematoma expansion, and to evaluate the added value of single-phase and multiphase CTA over NCCT. Methods: After prospectively deriving NCCT, single-phase CTA, and multiphase CTA hematoma expansion scores in 156 patients with ICH < 6 h, we validated them in 120 different patients. Discrimination and calibration of the three scores was assessed. Primary outcome was substantial hematoma expansion > 6 mL or > 33% at 24 h. Results: The evaluation of single-phase and multiphase CTA markers gave a steadily increase in discrimination for substantial hematoma expansion over NCCT markers. The C-index (95% confidence interval) in derivation and validation cohorts was 0.69 (0.58–0.80) and 0.59 (0.46–0.72) for NCCT score, significantly lower than 0.75 ([0.64–0.87], p = 0.038) and 0.72 ([0.59–0.84], p = 0.016) for single-phase CTA score, and than 0.79 ([0.68–0.89], p = 0.033) and 0.73 ([0.62–0.85], p = 0.031) for multiphase CTA score, respectively. The three scores showed good calibration in both derivation and validation cohorts: NCCT (χ² statistic 0.389, p = 0.533; and χ² statistic 0.352, p = 0.553), single-phase CTA (χ² statistic 2.052, p = 0.359; and χ² statistic 2.230, p = 0.328), and multiphase CTA (χ² statistic 0.559, p = 0.455; and χ² statistic 0.020, p = 0.887) scores, respectively. Conclusion: This study shows the added prognostic value of more advanced CT modalities in acute ICH evaluation. NCCT, single-phase CTA, and multiphase CTA scores may help to refine the selection of patients at risk of expansion in different decision-making scenarios. Key Points: • This study shows the added prognostic value of more advanced CT modalities in acute intracerebral hemorrhage evaluation. • The evaluation of single-phase and multiphase CTA markers provides a steadily increase in discrimination for intracerebral hemorrhage expansion over non-contrast CT markers. • Non-contrast CT, single-phase CTA, and multiphase CTA scores may help clinicians and researchers to refine the selection of patients at risk of intracerebral hemorrhage expansion in different decision-making scenarios.