Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage.
BACKGROUND
Patients with acute intracerebral hemorrhage (ICH) presenting within 3 hours of symptom onset are known to be at increased risk of expansion. However, only a minority arrive within this time frame. Therefore, alternative markers for expansion risk are needed.


OBJECTIVE
To examine whether contrast extravasation on CT angiography (CTA) at presentation predicts subsequent hematoma expansion.


METHODS
Consecutive patients with primary ICH presenting to an urban tertiary care hospital were prospectively captured in a database. We retrospectively reviewed images for all patients receiving a CTA and at least one further CT scan within 48 hours.


RESULTS
Complete data were available for 104 patients. Contrast extravasation at the time of CTA was present in 56% of patients, and associated with an increased risk of hematoma expansion (22% vs 2%, p = 0.003). Patients who received a baseline CTA within 3 hours were more likely to have subsequent expansion (27%, vs 13% for those presenting later, p = 0.1). However, after multivariable analysis, contrast extravasation was the only significant predictor of hematoma expansion (OR 18, 95% CI 2.1 to 162). This effect was independent of time to presentation.


CONCLUSIONS
Contrast extravasation is independently associated with hematoma expansion. Patients presenting within the first few hours after symptom onset have traditionally been considered those at highest risk of expansion. However, for those presenting later, the presence of contrast may be a useful marker to guide therapies aimed at decreasing this risk.
Goldstein
J N
JN
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. jgoldstein@partners.org
Fazen
L E
LE
Snider
R
R
Schwab
K
K
Greenberg
S M
SM
Smith
E E
EE
Lev
M H
MH
Rosand
J
J
D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D003287:Contrast Media / Q000493:pharmacokinetics; D018450:Disease Progression; D042241:Early Diagnosis; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media