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From the Departments of Emergency Medicine (J.N.G.), Neurology (L.E.F., R.S., K.S., S.M.G., E.E.S., J.R.), and Radiology (M.H.L.), the Center for Human Genetic Research (L.E.F., R.S., J.R.), Massachusetts General Hospital, Boston.
Address correspondence and reprint requests to Dr. Joshua N. Goldstein, Department of Emergency Medicine, Massachusetts General Hospital, Clinics 115, 55 Fruit Street, Boston, MA 02114; e-mail: jgoldstein{at}partners.org
Background: Patients with acute intracerebral hemorrhage (ICH) presenting within 3 hours of symptom onset are known to be at increased risk of expansion. However, only a minority arrive within this time frame. Therefore, alternative markers for expansion risk are needed.
Objective: To examine whether contrast extravasation on CT angiography (CTA) at presentation predicts subsequent hematoma expansion.
Methods: Consecutive patients with primary ICH presenting to an urban tertiary care hospital were prospectively captured in a database. We retrospectively reviewed images for all patients receiving a CTA and at least one further CT scan within 48 hours.
Results: Complete data were available for 104 patients. Contrast extravasation at the time of CTA was present in 56% of patients, and associated with an increased risk of hematoma expansion (22% vs 2%, p = 0.003). Patients who received a baseline CTA within 3 hours were more likely to have subsequent expansion (27%, vs 13% for those presenting later, p = 0.1). However, after multivariable analysis, contrast extravasation was the only significant predictor of hematoma expansion (OR 18, 95% CI 2.1 to 162). This effect was independent of time to presentation.
Conclusions: Contrast extravasation is independently associated with hematoma expansion. Patients presenting within the first few hours after symptom onset have traditionally been considered those at highest risk of expansion. However, for those presenting later, the presence of contrast may be a useful marker to guide therapies aimed at decreasing this risk.
Commentary, see page 883
Supported by The National Institute of Neurological Disorders and Stroke (NIH 1 K23 NS42695-01, R01 NS04217), and the Jerome Lyle Rappaport Charitable Foundation.
Disclosure: Dr. Rosand has received research support, consulting, and speaking fees from NovoNordisk A/S. Dr. Goldstein has received consulting and speaking fees from NovoNordisk A/S. Dr. Lev has received educational support, consulting, and speaking fees from GE Healthcare, consulting and speaking fees from Bracco Diagnostics, and consulting fees from Coaxia. No compensation or fees were in excess of $10,000.
Received August 2, 2006. Accepted in final form November 21, 2006.
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