ArticleNeuroradiology2026
Predictive performance of non-contrast CT signs for hematoma expansion: A comparative analysis across traditional, revised, and conservative definitions.
Article in Neuroradiology, 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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Abstract
backgroundHematoma expansion (HE) is a critical determinant of neurological deterioration after spontaneous intracerebral hemorrhage (ICH). While non-contrast CT (NCCT) signs (Blend sign, Black hole sign, Hypodensities) are established predictors under traditional parenchymal-volume-based HE definitions, their performance under a revised composite definition that includes intraventricular hemorrhage (IVH) expansion remains unvalidated.
methodsIn a retrospective cohort of 685 spontaneous ICH patients, HE was assessed using three definitions: traditional (parenchymal increase > 6 mL or > 33%), revised (traditional criteria and/or IVH expansion [≥ 1 mL or new IVH]), and conservative revised (IVH threshold > 2 mL). Multivariable logistic regression evaluated the independent association of NCCT signs with each definition. Model discrimination was compared using ROC analysis.
resultsHE incidence was 17.08% (traditional), 21.90% (revised), and 20.15% (conservative revised). All three NCCT signs remained strong, independent predictors across all definitions after full adjustment (all p < 0.001), with no significant multicollinearity. The combined predictive model (clinical variables + all three signs) showed excellent and comparable discrimination for traditional (AUC = 0.867) and revised (AUC = 0.821) definitions (P = 0.13). A strong, identical inverse relationship between time-from-onset and HE risk was observed across all definitions. The revised definition captured all cases of severe HE (> 12.5 mL or > 50% growth) and identified an additional subgroup with isolated IVH expansion.
conclusionThe Blend sign, Black hole sign, and Hypodensities are robust predictors of HE that generalize effectively from traditional to IVH-inclusive composite definitions. Their predictive utility, combined with the time-dependent risk profile, supports their use for early, universal risk stratification in acute ICH, irrespective of the specific HE definition employed.
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