Radiological Indicators of Haematoma Expansion in Spontaneous ICH: Systematic Review and Meta-Analysis
Abstract
Introduction: Haematoma expansion in spontaneous intracerebral haemorrhage (ICH) is a key predictor of poor neurological outcomes. Early identification of patients at risk for expansion is essential for timely intervention. This systematic review and meta-analysis evaluated radiological indicators of haematoma expansion, including the island sign, hypodensities, spot sign, swirl sign, and black hole sign. Methods: A comprehensive search across multiple databases identified studies examining radiological predictors of haematoma expansion in spontaneous ICH. Quality assessment tools, such as the Newcastle-Ottawa Scale for observational studies, Cochrane Risk of Bias Tool for RCTs, and AMSTAR 2 for meta-analyses, were used to evaluate study quality. Results: Data synthesis revealed that the island sign and spot sign are strong predictors, with the spot sign being more significant on dual-energy CT imaging. Hypodensities, swirl sign, and black hole sign are moderate to strong predictors. Combining multiple indicators improved predictive accuracy. Meta-analysis revealed large, statistically significant negative standardized mean differences for hypodensities, spot sign, and island sign (p < 0.001), underscoring their reliability as imaging biomarkers for haematoma expansion in ICH. Conclusions: These findings suggest that incorporating radiological indicators into clinical protocols can enhance early identification and intervention strategies. Further research is needed to…
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