Validation and Comparison of Noncontrast CT Scores to Predict Intracerebral Hemorrhage Expansion.
BACKGROUND AND PURPOSE
The BAT, BRAIN, and HEP scores have been proposed to predict hematoma expansion (HE) with noncontrast computed tomography (NCCT). We sought to validate these tools and compare their diagnostic performance.


METHODS
We retrospectively analyzed two cohorts of patients with primary intracerebral hemorrhage. HE expansion was defined as volume growth > 33% or > 6 mL. Two raters analyzed NCCT scans and calculated the scores, blinded to clinical and imaging data. The inter-rater reliability was assessed with the interclass correlation statistic. Discrimination and calibration were calculated with area under the curve (AUC) and Hosmer-Lemeshow χ2 statistic, respectively. AUC comparison between different scores was explored with DeLong test. We also calculated the sensitivity, specificity, positive, and negative predictive values of the dichotomized scores with cutoffs identified with the Youden's index.


RESULTS
A total of 230 subjects were included, of whom 86 (37.4%) experienced HE. The observed AUC for HE were 0.696 for BAT, 0.700 for BRAIN, and 0.648 for HEP. None of the scores had a significantly superior AUC compared with the others (all p > 0.4). All the scores had good calibration (all p > 0.3) and good-to-excellent inter-rater reliability (interclass correlation > 0.8). BAT ≥ 3 showed the highest specificity (0.81), whereas BRAIN ≥ 6 had the highest sensitivity (0.76).


CONCLUSIONS
The BAT, BRAIN, and HEP scores can predict HE with acceptable discrimination and require just a baseline NCCT scan. These tools may be used to stratify the risk of HE in clinical practice or randomized controlled trials.
['Poli|Loris|L|http://orcid.org/0000-0003-4912-818X', 'Leuci|Eleonora|E|', 'Costa|Paolo|P|', 'De Giuli|Valeria|V|', 'Caria|Filomena|F|', 'Candeloro|Elisa|E|', 'Persico|Alessandra|A|', 'Gamba|Massimo|M|', 'Magoni|Mauro|M|', 'Micieli|Giuseppe|G|', 'Cavallini|Anna|A|', 'Padovani|Alessandro|A|', 'Pezzini|Alessandro|A|', 'Morotti|Andrea|A|']
D000368:Aged D000369:Aged, 80 and over D002543:Cerebral Hemorrhage D018450:Disease Progression D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D014057:Tomography, X-Ray Computed
Score Intracerebral hemorrhage BAT BRAIN HEP Hematoma expansion STROKE