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 validate these findings across diverse populations and advanced imaging techniques to improve patient outcomes.