Clinical Report: The Role of Non-Contrast CT Attenuation Values in Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

Overview

This study evaluates the predictive value of relative CT attenuation in forecasting hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH). A relative CT attenuation threshold of 33.35 Hounsfield units (HUs) was identified as significant for predicting HE.

Background

Spontaneous intracerebral hemorrhage (sICH) is a critical subtype of stroke, associated with high mortality and morbidity. Early hematoma expansion is a key factor influencing patient outcomes.

Data Highlights

Key Findings

• Relative CT attenuation value can independently predict HE in sICH patients (p = 0.006).
• A relative CT attenuation value of ≤33.35 HUs indicates a significant risk for HE.
• Of patients with relative CT attenuation ≤33.35 HU, 40.9% exhibited HE.
• The AUC for predicting HE with a relative CT attenuation of ≤33.35 HU was 0.647 (95% CI: 0.589–0.705).
• HE typically occurs within the first 24 hours after symptom onset, making early prediction crucial.

Clinical Implications

The identification of a critical CT attenuation threshold can aid clinicians in assessing the risk of hematoma expansion in sICH patients.

Conclusion

Relative CT attenuation values provide a tool for predicting hematoma expansion in sICH.

Related Resources & Content

1. European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS), 2025 -- Guideline on stroke due to spontaneous intracerebral haemorrhage
2. European Radiology, 2023 -- Predictive Features of Non-contrast CT for Growth of Intraventricular Hemorrhage
3. Frontiers in Neurology, 2026 -- Imaging studies for predicting hematoma expansion: from traditional imaging signs to artificial intelligence-based multimodal fusion
4. Frontiers in Neurology, 2026 -- The “brush sign”: a novel and accessible CT marker for hematoma expansion in hypertensive intracerebral hemorrhage
5. npj Digital Medicine, 2025 -- An end-to-end deep learning pipeline for hematoma expansion prediction in spontaneous intracerebral hemorrhage based on non-contrast computed tomography
6. European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage
7. https://www.nature.com/articles/s41598-025-18409-9.pdf
8. Tranexamic acid for spontaneous intracerebral hemorrhage: hematoma control without clinical benefits? A meta-analysis of RCTs | Naunyn-Schmiedeberg's Archives of Pharmacology | Springer Nature Link