NCCT血肿密度不均匀对自发性脑出血患者血肿扩大及预后不良预测价值的研究进展

doi:10.3969/j.issn.1673-5765.2025.08.013

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (8): 1035-1041.DOI: 10.3969/j.issn.1673-5765.2025.08.013

NCCT血肿密度不均匀对自发性脑出血患者血肿扩大及预后不良预测价值的研究进展

付媛媛¹，王丽琨^1，2

1 贵阳 550004 贵州医科大学附属医院急诊医学科
2 贵州医科大学校级重点实验室

收稿日期:2024-12-11 修回日期:2025-07-18 接受日期:2025-07-25 出版日期:2025-08-20 发布日期:2025-08-20
通讯作者: 王丽琨 769070308@qq.com
基金资助:
贵州医科大学附属医院学科领军人才项目（gyfyxkrc-2023-05）
贵州医科大学校级重点实验室建设项目（[2024]fy007）

Research Progress on the Predictive Value of Heterogeneous Hematoma Density on NCCT for Hematoma Expansion and Poor Prognosis in Patients with Spontaneous Intracerebral Hemorrhage

FU Yuanyuan¹, WANG Likun^1,2

1 Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
2 University-Level Key Laboratory of Guizhou Medical University, Guiyang 550004, China

Received:2024-12-11 Revised:2025-07-18 Accepted:2025-07-25 Online:2025-08-20 Published:2025-08-20
Contact: WANG Likun, E-mail: 769070308@qq.com

摘要/Abstract

摘要： 自发性脑出血是一种高发病率、高死亡率的卒中类型，主要有高血压脑出血、脑淀粉样血管病脑出血及原因不明脑出血。血肿扩大是自发性脑出血患者预后不良的危险因素之一。对存在血肿扩大风险的自发性脑出血患者进行预防性治疗可能改善其预后，因此，用于快速筛选血肿扩大高危患者的可靠影像学标志物已成为临床研究的重点。近年来大量研究表明，头颅非对比计算机断层扫描血肿密度不均匀是自发性脑出血患者血肿扩大及预后不良的预测因子，但目前该结论仍存在争议。本文对相关研究进展进行系统整理和归纳，以期为临床诊疗提供参考。

文章导读： 本文综述了血肿密度不均匀对自发性脑出血患者血肿扩大及预后不良的影响，提示血肿密度不均匀可作为筛选血肿扩大的影像学标志物，为临床诊疗提供了一定依据。

关键词: 自发性脑出血; 影像学标志物; 多模态影像; 预后; 血肿扩大

Abstract: Spontaneous intracerebral hemorrhage is a stroke subtype characterized by high morbidity and mortality. It encompasses hypertensive cerebral hemorrhage, cerebral amyloid angiopathy-related intracerebral hemorrhage, and cryptogenic intracerebral hemorrhage. Hematoma expansion is considered one of the risk factors for poor prognosis in patients with spontaneous intracerebral hemorrhage. Prophylactic treatment for spontaneous intracerebral hemorrhage patients at risk of hematoma expansion may improve their outcomes. Therefore, reliable imaging biomarkers for the rapid screening of high-risk patients with hematoma expansion have become a focus in clinical research. In recent years, a large number of clinical studies have shown that heterogeneous hematoma density on head non-contrast computed tomography is a predictor of hematoma expansion and poor prognosis in patients with spontaneous intracerebral hemorrhage. However, this conclusion remains controversial. This article systematically reviews and summarizes the related research progress, aiming to provide references for clinical diagnosis and treatment.

Key words: Spontaneous intracerebral hemorrhage; Imaging marker; Multimodal imaging; Prognosis; Hematoma expansion

中图分类号:

付媛媛, 王丽琨. NCCT血肿密度不均匀对自发性脑出血患者血肿扩大及预后不良预测价值的研究进展[J]. 中国卒中杂志, 2025, 20(8): 1035-1041.

FU Yuanyuan, WANG Likun. Research Progress on the Predictive Value of Heterogeneous Hematoma Density on NCCT for Hematoma Expansion and Poor Prognosis in Patients with Spontaneous Intracerebral Hemorrhage[J]. Chinese Journal of Stroke, 2025, 20(8): 1035-1041.

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https://www.chinastroke.org.cn/CN/Y2025/V20/I8/1035

参考文献

[1] SHETH K N. Spontaneous intracerebral hemorrhage[J]. N Engl J Med，2022，387（17）：1589-1596.
[2] MAGID-BERNSTEIN J，GIRARD R，POLSTER S，et al. Cerebral hemorrhage：pathophysiology，treatment，and future directions[J]. Circ Res，2022，130（8）：1204-1229.
[3] TANAKA K，TOYODA K. Clinical strategies against early hematoma expansion following intracerebral hemorrhage[J/OL]. Front Neurosci，2021，15：677744[2025-01-13]. https://doi.org/10.3389/fnins.2021.677744.
[4] HORN M，TELEG E，TANAKA K，et al. Timing of spot sign appearance，spot sign volume，and leakage rate among phases of multiphase CTA predict intracerebral hemorrhage growth[J]. AJNR Am J Neuroradiol，2024，45（6）：693-700.
[5] TAKEDA R，OGURA T，OOIGAWA H，et al. A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage[J]. Clin Neurol Neurosurg，2013，115（7）：1028-1031.
[6] BARRAS C D，TRESS B M，CHRISTENSEN S，et al. Density and shape as CT predictors of intracerebral hemorrhage growth[J]. Stroke，2009，40（4）：1325-1331.
[7] MOROTTI A，BOULOUIS G，DOWLATSHAHI D，et al. Standards for detecting，interpreting，and reporting noncontrast computed tomographic markers of intracerebral hemorrhage expansion[J]. Ann Neurol，2019，86（4）：480-492.
[8] NEW P F，ARONOW S. Attenuation measurements of whole blood and blood fractions in computed tomography[J]. Radiology，1976，121（3）：635-640.
[9] NORMAN D，PRICE D，BOYD D，et al. Quantitative aspects of computed tomography of the blood and cerebrospinal fluid[J]. Radiology，1977，123（2）：335-338.
[10] ITO H，MAEDA M，UEHARA T，et al. Attenuation values of chronic subdural haematoma and subdural effusion in CT scans[J]. Acta Neurochir（Wien），1984，72（3/4）：211-217.
[11] CHEN K，DENG L J，LI Q，et al. Are computed-tomography-based hematoma radiomics features reproducible and predictive of intracerebral hemorrhage expansion？An in vitro experiment and clinical study[J/OL]. Br J Radiol，2021，94（1121）：20200724[2025-01-13]. https://doi.org/10.1259/bjr.20200724.
[12] BOULOUIS G，MOROTTI A，CHARIDIMOU A，et al. Noncontrast computed tomography markers of intracerebral hemorrhage expansion[J]. Stroke，2017，48（4）：1120-1125.
[13] DELCOURT C，ZHANG S H，ARIMA H，et al. Significance of hematoma shape and density in intracerebral hemorrhage：the intensive blood pressure reduction in acute intracerebral hemorrhage trial study[J]. Stroke，2016，47（5）：1227-1232.
[14] ZHAO M P，HUANG W，HUANG S N，et al. Quantitative hematoma heterogeneity associated with hematoma growth in patients with early intracerebral hemorrhage[J/OL]. Front Neurol，2022，13：999223[2025-01-13]. https://doi.org/10.3389/fneur.2022.999223.
[15] BOULOUIS G，MOROTTI A，BROUWERS H B，et al. Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage[J]. JAMA Neurol，2016，73（8）：961-968.
[16] CHEN Y H，CHANG J B，LIU J F，et al. Validation of perihematomal edema expansion as a new imaging biomarker to predict clinical outcome in patients with intracerebral hemorrhage[J/OL]. J Stroke Cerebrovasc Dis，2022，31（9）：106692[2025-01-13]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106692.
[17] LI Y L，ZHENG Y N，ZHANG L J，et al. Comparison of different noncontrast computed tomographic markers for predicting early perihematomal edema expansion in patients with intracerebral hemorrhage[J/OL]. J Clin Neurosci，2023，112：1-5[2025-01-13]. https://doi.org/10.1016/j.jocn.2023.03.006.
[18] LI Y L，LYU X N，WEI X，et al. Relationship between non-contrast computed tomography imaging markers and perihemorrhagic edema growth in intracerebral hemorrhage[J]. Neurocrit Care，2021，35（2）：451-456.
[19] YU Z Y，MA L，ZHENG J，et al. Comparison of hematoma density heterogeneity and ultraearly hematoma growth in predicting hematoma expansion in patients with spontaneous intracerebral hemorrhage[J/OL]. J Neurol Sci，2017，379：44-48[2025-01-13]. https://doi.org/10.1016/j.jns.2017.05.049.
[20] MOROTTI A，BOULOUIS G，ROMERO J M，et al. Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion[J]. Neurology，2017，89（6）：548-554.
[21] YU Z Y，ZHENG J，XU Z，et al. Accuracy of shape irregularity and density heterogeneity on noncontrast computed tomography for predicting hematoma expansion in spontaneous intracerebral hemorrhage：a systematic review and meta-analysis[J/OL]. World Neurosurg，2017，108：347-355[2025-01-13]. https://doi.org/10.1016/j.wneu.2017.09.022.
[22] MOROTTI A，DOWLATSHAHI D，BOULOUIS G，et al. Predicting intracerebral hemorrhage expansion with noncontrast computed tomography：the BAT score[J]. Stroke，2018，49（5）：1163-1169.
[23] ELKHATIB T H M，SHEHTA N，BESSAR A A. Hematoma expansion predictors：laboratory and radiological risk factors in patients with acute intracerebral hemorrhage：a prospective observational study[J]. J Stroke Cerebrovasc Dis，2019，28（8）：2177-2186.
[24] MOROTTI A，BOULOUIS G，CHARIDIMOU A，et al. Imaging markers of intracerebral hemorrhage expansion in patients with unclear symptom onset[J]. Int J Stroke，2022，17（9）：1013-1020.
[25] KIM Y S，CHAE H Y，JEONG H G，et al. Size-related differences in computed tomography markers of hematoma expansion in acute intracerebral hemorrhage[J]. Neurocrit Care，2022，36（2）：602-611.
[26] YU L H，ZHAO M P，LIN Y X，et al. Noncontrast computed tomography markers associated with hematoma expansion：analysis of a multicenter retrospective study[J/OL]. Brain Sci，2023，13（4）：608[2025-01-13]. https://doi.org/10.3390/brainsci13040608.
[27] SONG L，QIU X M，ZHANG C，et al. Combining non-contrast CT signs with onset-to-imaging time to predict the evolution of intracerebral hemorrhage[J]. Korean J Radiol，2024，25（2）：166-178.
[28] MOROTTI A，LI Q，NAWABI J，et al. Predictors of severe intracerebral hemorrhage expansion[J]. Eur Stroke J，2024，9（3）：623-629.
[29] MOROTTI A，LI Q，MAZZOLENI V，et al. Non-contrast CT markers of intracerebral hemorrhage expansion：the influence of onset-to-CT time[J]. Int J Stroke，2023，18（6）：704-711.
[30] BOULOUIS G，MOROTTI A，BROUWERS H B，et al. Noncontrast computed tomography hypodensities predict poor outcome in intracerebral hemorrhage patients[J]. Stroke，2016，47（10）：2511-2516.
[31] SPORNS P B，KEMMLING A，SCHWAKE M，et al. Triage of 5 noncontrast computed tomography markers and spot sign for outcome prediction after intracerebral hemorrhage[J]. Stroke，2018，49（10）：2317-2322.
[32] MOROTTI A，ARBA F，BOULOUIS G，et al. Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome：a meta-analysis[J]. Neurology，2020，95（14）：632-643.
[33] DE OLIVEIRA MANOEL A L. Surgery for spontaneous intracerebral hemorrhage[J/OL]. Crit Care，2020，24：45[2025-01-13]. https://doi.org/10.1186/s13054-020-2749-2.
[34] YAGI K，TAO Y，HARA K，et al. Does noncontrast computed tomography scan predict rebleeding after endoscopic surgery for spontaneous intracerebral hemorrhage？[J/OL]. World Neurosurg，2019，127：e965-e971[2025-01-13]. https://doi.org/10.1016/j.wneu.2019.04.010.

NCCT血肿密度不均匀对自发性脑出血患者血肿扩大及预后不良预测价值的研究进展

Research Progress on the Predictive Value of Heterogeneous Hematoma Density on NCCT for Hematoma Expansion and Poor Prognosis in Patients with Spontaneous Intracerebral Hemorrhage

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