Hematoma Heterogeneity on Noncontrast Computed Tomography Predicts Intracerebral Hematoma Expansion: A Meta-Analysis

BACKGROUND: Hematoma expansion (HE) is independently associated with clinical outcome after intracerebral hemorrhage (ICH). Hematoma heterogeneity on noncontrast computed tomography (NCCT) is reportedly predictive of HE, but conclusions are inconsistent. We sought to clarify the relationship between hematoma heterogeneity and HE by pooling the pertinent publications. METHODS: The Cochrane Library, PubMed, and Embase were searched for related studies examining the correlation of HE with hematoma heterogeneity, and the secondary endpoint was defined as poor outcome. The effect size was odds ratio (OR) with its 95% confidence interval (CI). Results from each study were pooled using a random-effects model. RESULTS: Ten studies were included with a total of 5931 patients and 675 HEs. We detected a statistically significant association between NCCT heterogeneity and HE (OR, 2.55; 95% CI, 1.82-3.56; P < 0.001), while the correlation with poor outcome was nonsignificant (OR, 1.20; 95% CI, 0.94-1.54, P = 0.15). CONCLUSIONS: Our findings indicate that hematoma heterogeneity on NCCT is positively associated with an increased risk of HE. The relationship between hematoma heterogeneity and poor outcome merits evaluation in further prospective studies.