Evidence map›Paper›PMID 41614507›Full record

ArticleEuropean stroke journal2026

Ultra-early computed tomography markers of haematoma expansion: Potential trial targets?

Chloe A Mutimer, Sameer Sharma, Henry Zhao, Atte Meretoja, Leonid Churilov, Teddy Y Wu, Timothy J Kleinig, Philip M Choi, Andrew Cheung, Jiann-Shing Jeng and 8 more

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In one paragraph

Article in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Chloe A MutimerDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.ORCID 0000-0001-9143-5760
Sameer SharmaDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Henry ZhaoDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.ORCID 0000-0002-4320-4287
Atte MeretojaDepartment of Neurology, Helsinki University Hospital, Helsinki, Finland.
Leonid ChurilovDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.ORCID 0000-0002-9807-6606
Teddy Y WuDepartment of Neurology, Christchurch Hospital, Christchurch, New Zealand.ORCID 0000-0003-1845-1769
Timothy J KleinigDepartment of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia.ORCID 0000-0003-4430-3276
Philip M ChoiDepartment of Neuroscience, Box Hill Hospital, Eastern Health, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia.
Andrew CheungDepartment of Interventional Neuroradiology, Liverpool Hospital, Liverpool, NSW, Australia.
Jiann-Shing JengDepartment of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
Henry MaDepartment of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
Duy Ton MaiStroke Centre, Bach Mai Hospital, Hanoi Medical University, VNU University of Medicine and Pharmacy, Hanoi, Viet Nam.ORCID 0000-0002-7210-3522
Huy-Thang NguyenDepartment of Cerebrovascular Disease, 115 Hospital, Ho Chi Minh City, Viet Nam.
Gagan SharmaDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Bruce C V CampbellDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Geoffrey A DonnanDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Stephen M DavisDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
Nawaf YassiDepartment of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.

Funding

Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Australian Government Research Training Program ScFaculty of Medicine, Dentistry and Health Sciences, University of Melbourne Rowden White Scholarship
6 · The paper itself

Abstract

introductionThe predictive value of CT markers of intracerebral haemorrhage (ICH) expansion is time-dependent, but data in the ultra-early period (<2 h from onset) are limited. We aimed to describe the frequency of these CT markers, their association with haematoma volume, haematoma expansion (HE) and functional outcome at 90-days. We also investigated the effect of tranexamic acid on HE in the presence of these markers. PATIENTS AND

methodsWe performed a pooled analysis of individual patient data from the STOP-AUST and STOP-MSU placebo-controlled randomised trials of tranexamic acid, including ICH patients scanned within 2 h of symptom onset. Logistic regression was used to assess the association between CT markers and HE or 90-days functional outcomes (poor outcome defined as mRS3-6).

resultsAmong 246 patients, the swirl sign (74.3%) was the most frequent CT marker and the blend sign least frequent (7.3%). All markers were associated with increased baseline haematoma volume, and excluding the black hole sign, all were more common in patients with 24-h HE. The blend and spot signs were associated with 24-h HE and heterogenous density, swirl sign, hypodensity and island sign were associated with poor 90-day function outcomes in univariate logistic regression. However, the area under the receiver-operating-characteristic curve was similar for all markers and indicated low discriminative ability (Chi-squared test p = 0.81). A potential benefit of tranexamic acid in HE reduction was observed in patients with the spot sign (interaction p = 0.01).

conclusionsThe discriminative utility of CT markers of HE in the early timeframe appears insufficient. There may be an effect of tranexamic acid in spot sign positive patients <2 h from onset.

Indexed as

Cerebral HemorrhageHematomaTomography, X-Ray ComputedAgedAntifibrinolytic AgentsBiomarkersFemaleHumansMaleMiddle AgedTranexamic AcidAntifibrinolytic AgentsBiomarkersTranexamic Acidcomputed tomographyhaematoma expansionIntracerebral haemorrhageprognosis

Identifiers

PMID41614507
PMCPMC12866209

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.