Presenter of 1 Presentation
EFFECTS OF RATIO OF HAEMATOMA VOLUME TO INTRACRANIAL VOLUME ON HAEMATOMA GROWTH AND MASS EFFECT: POST-HOC ANALYSIS OF RIGHT-2 TRIAL
Abstract
Background and Aims
The risk of haematoma expansion in intracerebral haemorrhage (ICH) increases with larger baseline volume until haemostasis or a tamponade is effected by the rigid cranium. We explored the association of ICH volume to intracranial volume ratio (ICH/ICV) with mass effect and whether it could predict haematoma expansion at 24-hour.
Methods
CT scans of 133 patients with ICH in the RIGHT-2 trial were analysed. ICH/ICV ratio (%) was estimated using semi-automated segmentation methods. Significant mass effect was defined as midline shift of ≥5mm or ambient cistern score of ≥1 (effacement of at least one ambient cistern). Multivariable logistic regression with adjustment for baseline variables was performed to explore the predictors of haematoma expansion (>6mL or >33%) and significant mass effect.
Results
The mean baseline ICH volume was 37.8 (38.6) mL and mean ICH/ICV ratio 2.68 (2.72)%. ICH/ICV ratio of ≥6% was significantly associated with ambient cistern effacement (adjusted odd ratio [aOR] 21.6, 95%CI 5.5-84.8) and midline shift ≥5mm (aOR 220) on baseline CT but not at lower cut-offs. Increasing ICH/ICV ratio predicted haematoma expansion but the effect plateaued at 3-4% when further increase did not significantly increase the aOR (Figure 1). The accuracy of ICH/ICV ratio in predicting haematoma expansion was similar compared to ICH volume (area under the receiver operator characteristics curve 0.69 for both, Figure 2).
Conclusions
ICH/ICV ratio predicted haematoma expansion and may be used to prognosticate or stratify patients in stroke trials testing potential treatments. The potential mechanisms and effect on functional outcomes need further exploration.