Prediction of hematoma expansion in deep intracerebral hemorrhage using baseline non-contrast CT and clinical variables: a multicenter multimodal study

Hematoma expansion (HE) is a major determinant of neurological deterioration and poor outcome after intracerebral hemorrhage (ICH), yet early risk stratification remains challenging. We developed and validated a multicenter multimodal model for predicting HE in patients with deep ICH using baseline non-contrast computed tomography (NCCT) and clinical variables. In this retrospective study, 539 patients from three hospitals were included, including 229 in the training cohort, 99 in the validation cohort, and 211 in the independent external test cohort; 98 patients (18.2%) experienced HE.

Baseline NCCT images were converted into 2.5D inputs using the slice with the largest hematoma area and adjacent slices. Deep imaging features were extracted and fused with clinical variables, followed by feature selection and classifier construction. The Transformer-hybrid model achieved the AUC of 0.839 in the external test cohorts.

In the external test cohort, the model achieved high specificity at the default threshold and showed a higher AUC than all six baseline NCCT radiological signs, whose highest AUC was 0.569. This 2.5D multimodal framework may serve as a candidate adjunctive approach for early HE risk stratification in deep ICH and requires prospective validation before clinical use. This research was funded by the Natural Science Foundation of Zhejiang Province of China, grant numbers LTGC23H090003.

Department of Radiology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China Guolan Song, Yue Wang, Qingdian Cong, Junli Wang & Sheng Hu Department of Neurology, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China Department of Neurosurgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China Department of Radiology, Yiwu Chouzhou Hospital, Yiwu, 322000, China Department of Radiology, The Yiwu Traditional Chinese Medicine Hospital, Yiwu, 322000, China Xueqing Lv, Yongren Wang, Xuan Cheng & Jin Wang The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Song, G., Shen, Y., Zhou, J. et al. Prediction of hematoma expansion in deep intracerebral hemorrhage using baseline non-contrast CT and clinical variables: a multicenter multimodal study.