European Radiology: Are unenhanced CT signs that can indicate the progression of intracranial hematoma really reliable?

Intracerebral hematoma enlargement (HE) occurs in approximately one third of patients with spontaneous intracerebral hemorrhage (ICH) and is independently associated with early neurological deterioration, dysfunction, and mortalit.

To circumvent this problem, investigators have developed various non-contrast CT (NCCT) hematoma expansion markers (EMs) that can assess hematoma density or shap.

A recent study standardized the definitions of nine NCCT hematoma EM.

A study published in the journal European Radiology assessed the reliability of all nine NCCT hematoma EMs in a diverse sample of clinicians involved in the care of patients with ICH, assessed interobserver agreement, defined EM, assessed The influence of the patient experience, hematoma characteristics and anticoagulation status on the consistency between assessors and the consistency with reference reading results provide a reference for accurate clinical application and assessmen.

This study randomly selected 60 patients diagnosed with spontaneous ICH from a local datase.

Nearly perfect inter-rater agreement was observed for swirl (85, 95%CI: 78-90) and level (84, 95%CI: 76-90) markers, while low density (67, 95%CI: 76-90) markers 56-76) and mixed (62, 95% CI: 51-71) markers showed significant agreemen.

In a large sample of raters with different backgrounds and levels of expertise, only 4 of the 9 extended assessments of ICH on unenhanced CT signs showed significant inter-rater agreement, suggesting future use of NCCT for hematoma Studies of EMs should consider the re-accountability impact of EMs in the study design and simplify definitions or use automated processing and interpretation of NCCT image.

Original source:

Ahmad Nehme,Célina Ducroux,Marie-Andrée Panzini,et a.