Early NCCT imaging signs for prognostication in intracerebral hemorrhage: a retrospective cohort study with long follow up results

TL;DR

This study shows that early NCCT imaging signs in brain hemorrhage patients can improve long-term outcome predictions.

Contribution

The integration of NCCT imaging signs into prognostic models significantly improves accuracy for predicting outcomes in ICH patients.

Findings

Swirl sign, age, mRS score, and ventricular hemorrhage predict poor 3-month outcomes.

Island sign, age, mRS score, and HE predict poor 12-month outcomes.

Adding NCCT signs improves model accuracy at both 3 and 12 months.

Abstract

This study intends to investigate the connection between non-contrast computed tomography (NCCT) imaging findings and neurological function scores in patients with intracerebral hemorrhage (ICH) in a long follow up of 451 patients.

Between January 2020 and October 2021, a retrospective review was undertaken on patients with ICH. The NCCT imaging results within 24 h of symptom onset, clinical information, biochemical markers and the one-year outcome post-discharge were collected and analyzed. Subsequently, a prognostic model was devised to predict poor outcomes.

A cohort of 451 patients diagnosed with ICH was analyzed in this study. Adverse prognostic outcomes at three months were found to be independently associated with several factors, including the presence of the swirl sign (P = 0.010), advanced age (P = 0.003), post-ICH modified Rankin Scale (mRS) score (P = 0.003,), time elapsed from symptom onset to NCCT scan (P = 0.018), and the presence of ventricular hemorrhage (P = 0.003). Unfavorable prognosis at 12 months was independently associated with the presence of the island sign (P = 0.001), older age (P = 0.003), post-ICH mRS score (P = 0.003), and HE (P = 0.014). Additionally, the integration of NCCT imaging signs into the predictive model significantly improved its accuracy in predicting adverse outcomes at both three months (AUC = 0.817 vs. 0.782 in the model without NCCT, NRI = 0.219, P = 0.033, IDI = 0.080, P = 0.006) and 12 months (AUC = 0.829 vs. 0.797 in the model without NCCT, NRI = 0.235, P = 0.028, IDI = 0.096, P = 0.003).

The early imaging features of patients suffering from ICH can provide a more precise prognosis from the analysis of the 12-month follow up results.

The online version contains supplementary material available at 10.1186/s12883-025-04100-z.

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