Non-Contrast CT Yields Prognostic Findings in Hemorrhagic Stroke Interview with:


Dr. Gregoire Boulouis

Dr. Gregoire Boulouis MD MS
Research Fellow at Massachusetts General Hospital / Harvard Med. School
Boston, Massachusetts What is the background for this study? What are the main findings?

Dr. Boulouis: Hemorrhagic Stroke or Intracerebral hemorrhage (ICH) still has a poor prognosis. A substantial proportion of patients will experience ongoing intracranial bleeding and their hematomas will grow in size in the first hours following presentation, a phenomenon called ‘hemorrhage epxansion’. Patients with hemorrhage expansion have been shown to have significantly worse clinical outcome. If all baseline ICH characteristics (location, initial hemorrhage volume, ..) are non modifiable at the time of diagnosis, hemorrhage expansion, however, represents one of the few potential targets to improve outcome in ICH patients. An accurate selection of patients at high risk of expansion is needed to optimize patients’ selection in expansion targetted trials and, eventually, to help stratifying the level of care at the acute phase.

In this study, we investigated whether the presence of non-contrast Computed Tomography hypodensities within the baseline hematoma, a very easily and reliably assessed imaging marker, was associated with more hemorrhage expansion.

A total of 1029 acute phase ICH patients were included ; approximately a third of them demonstrated CT hypodensities at baseline. In this population, CT hypodensities were independently associated with hemorrhage expansion with an odds ratio of 3.42 (95% CI 2.21-5.31) for expansion in fully adjusted multivariable model. What should readers take away from your report?

Dr. Boulouis: The main message is that non-contrast CT can provide valuable information in regards to the risk of hemorrhage expansion (as  by previous works), and that hypodensities, a very simple marker, appeared to be a good candidate. As non contrast CT is widely available and commonly performed for acute ICH, our findings can be of prognostic significance in a wide variety of settings and may help target anti-expansion therapies to those most likely to benefit (e.g. patients at highest risk of expansion). These findings also add to our understanding of the dynamic intra-hematoma processes that indicate ongoing bleeding. What recommendations do you have for future research as a result of this study?

Dr. Boulouis: Our findings will first need replication on an independent population. Additionally, it is not currently clear what hypodensities really represent (e.g. active bleeding, immature hematoma, multiple sources of bleeding, …) thus future studies investigating the pathophysiological mechanisms underlying this imaging marker are needed.

Finally, given their association with hemorrhage expansion, baseline CT hypodensities represent a good candidate for ICH prognostication, and their association with clinical outcome also need to be explored. Is there anything else you would like to add?

Dr. Boulouis: : In this single center study we demonstrated that baseline non-contrast CT hypodensities were associated with a significantly higher risk of hemorrhage expansion, an ominous phenomenon in ICH patients. Replication studies are needed to confirm the position of CT hypodensities in the realm of ICH expansion predictors. Thank you for your contribution to the community.


upcoming JAMA publication:

Boulouis G, Morotti A, Brouwers H, et al. Association Between Hypodensities Detected by Computed Tomography and Hematoma Expansion in Patients With Intracerebral Hemorrhage. JAMA Neurol.Published online June 20, 2016. doi:10.1001/jamaneurol.2016.1218.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 21, 2016 by Marie Benz MD FAAD