The Attenuation Value Within the Non-hypodense Region on Non-contrast Computed Tomography of Spontaneous Cerebral Hemorrhage: A Long-Neglected Predictor of Hematoma Expansion

Yong Chen; Dan Cao; Zheng-Qian Guo; Xiao-Ling Ma; Yi-Bo Ou; Yue He; Xu Chen; Jian Chen

doi:10.3389/fneur.2022.785670

The Attenuation Value Within the Non-hypodense Region on Non-contrast Computed Tomography of Spontaneous Cerebral Hemorrhage: A Long-Neglected Predictor of Hematoma Expansion

Front Neurol. 2022 Apr 8:13:785670. doi: 10.3389/fneur.2022.785670. eCollection 2022.

Authors

Yong Chen¹, Dan Cao¹, Zheng-Qian Guo¹, Xiao-Ling Ma², Yi-Bo Ou¹, Yue He¹, Xu Chen¹, Jian Chen¹

Affiliations

¹ Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Background and purpose: The ability of attenuation value of the non-hypodense region of hematoma in non-contrast computed tomography (NCCT) for predicting hematoma expansion (HE) remains unclear. Our purpose is to explore this relationship.

Methods: Two cohorts of patients were collected for analysis. The region where we measured hematoma attenuation values was limited to the non-hypodense region that was not adjacent to the normal brain tissue on NCCT. The critical attenuation value was derived via receiver operating characteristic (ROC) curve analysis in the derivation cohort and its predictive ability was validated in the validation cohort. Independent relationships between predictors, such as critical attenuation value of the non-hypodense region and HE were analyzed using the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic analysis.

Results: The results showed that the attenuation value <64 Hounsfield units (HU) was independently associated with HE [odds ratio (OR), 4.118; 95% confidential interval (CI), 1.897-9.129, p < 0.001] and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) for predicting HE were 36.11%, 81.71%, 1.97, 0.78, 44.8%, 75.7%, and 0.589, respectively.

Conclusions: Our research explored and validated the relationship between the attenuation value of the non-hypodense region of hematoma and HE. The attenuation value < 64 HU was an appropriate indicator of early HE.

Keywords: Hounsfield units; attenuation value; hematoma expansion; non-contrast computed tomography; non-hypodense region; spontaneous intracerebral hemorrhage.