Comparison of hematoma density heterogeneity and ultraearly hematoma growth in predicting hematoma expansion in patients with spontaneous intracerebral hemorrhage

Background Hematoma density heterogeneity (HDH) and ultraearly hematoma growth (uHG) are novel imaging predictors for hematoma expansion (HE) based on computed tomography (CT). This study was aimed to compare the accuracy of HDH and uHG in HE prediction within a cohort of spontaneous intracerebral hemorrhage (sICH) patients. Methods This study included sICH patients with initial CT within 6 h after onset. uHG was defined as baseline hematoma volume/onset-to-CT time (ml/h) and the cutoff was 4.7 ml/h. HDH was evaluated following a 5-point categorical scale and HDH grade was dichotomized into homogeneous (1–2) and heterogeneous (3–5). The predictive accuracy of HDH and uHG was analyzed by receiver-operator analysis. Results A total of 137 patients were included in this study. The mean uHG and median HDH grade were significantly higher in patients with HE. In multivariable analysis, uHG ≥ 4.7 and HDH grade ≥ 3 were associated with HE independently. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of uHG ≥ 4.7 were 76.5%, 57.3%, 37.1%, and 88.1%, respectively. The sensitivity, specificity, PPV and NPV of HDH grade ≥ 3 were 55.9%, 70.9%, 39.8% and 83.0%, respectively. Conclusions Both HDH and uHG are promising predictors for HE. HDH has higher specificity while uHG is more sensitive.