Predictive validity of hypodensities on non-contrast computed tomography for hematoma growth in intracerebral hemorrhage: a meta-analysis.

OBJECTIVE: Intracerebral hemorrhage (ICH) is a kind of stroke which leads to high mortality. Hematoma growth (HG) happens in about one third of all ICH patients and independently related to poor outcome. Previous studies have shown that an indicator on non-contrast computed tomography (NCCT), called hypodensities, can predict HG in ICH patients. Thus, this study was done to assess that predictive validity of this marker for HG prediction.

METHODS: Bibliographic databases were searched without language restriction for original investigation on hypodensities an HG in ICH. Data were extracted, and study quality was assessed by two reviewers independently. Pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio, and their 95% confidence intervals (CIs) were obtained. A summary receiver operating characteristic (SROC) curve were depicted.

RESULTS: Five cohorts with 2157 patients in four studies were included in this meta-analysis. The pooled sensitivity was 0.58 (95%CI 0.46-0.68) and the pooled specificity was 0.71 (95%CI 0.62-0.79). In addition, the pooled positive LR was 2.0 (95%CI 1.6-2.5) and the pooled negative LR was 0.60(95%CI 0.49-0.73). The pooled diagnostic odds ratio was 3 (95%CI 2-5) and the area under SROC curve was 0.69 (95%CI 0.65-0.73).

CONCLUSIONS: This study suggests that hypodensities on NCCT can be helpful in HG prediction, although its pooled predictive values are not very satisfying in the current study. The role of hypodensities in predicting HG should be confirmed by further studies.