Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

The probability of cerebral amyloid angiopathy according to the Simplified Edinburgh CT criteria in a large, unselected lobar intracerebral hemorrhage population

Hillal, Amir LU ; Apostolaki-Hansson, Trine LU orcid ; Ramgren, Birgitta LU ; Hansen, Björn LU orcid ; Norrving, Bo LU ; Wassélius, Johan LU and Ullberg, Teresa LU (2025) In Neuroradiology 67(4). p.823-831
Abstract

PURPOSE: Early identification of the underlying cause of intracerebral hemorrhage (ICH) is important for treatment and prognosis. This study aims to investigate the association of hematoma volume and other clinical parameters on the distribution of cerebral amyloid angiopathy (CAA) probability according to the simplified Edinburgh CT criteria in a large, unselected intracerebral hemorrhage (ICH) population.

METHOD: Patients with spontaneous ICH residing in Skane county registered with clinical data in the Swedish Stroke Register 2016-2020 were included. Radiological parameters were evaluated using baseline non-contrast CT (NCCT) for categorization according to the simplified Edinburgh CT criteria by the presence of subarachnoid... (More)

PURPOSE: Early identification of the underlying cause of intracerebral hemorrhage (ICH) is important for treatment and prognosis. This study aims to investigate the association of hematoma volume and other clinical parameters on the distribution of cerebral amyloid angiopathy (CAA) probability according to the simplified Edinburgh CT criteria in a large, unselected intracerebral hemorrhage (ICH) population.

METHOD: Patients with spontaneous ICH residing in Skane county registered with clinical data in the Swedish Stroke Register 2016-2020 were included. Radiological parameters were evaluated using baseline non-contrast CT (NCCT) for categorization according to the simplified Edinburgh CT criteria by the presence of subarachnoid hemorrhage (SAH) and fingerlike-projections (FLP). Multivariable logistic regression analysis was used to determine factors associated with an increased (intermediate/high) CAA probability.

RESULTS: Of 666 patients with lobar ICH, 190 (29%) had high, 92 (14%) had intermediate, and 384 (58%) had low CAA probability. Patients with increased CAA probability presented more often with decreased level of consciousness, larger hematoma volumes, and higher 90-day mortality. Baseline hematoma volume [10-30 ml (OR = 4.03;95%CI: 2.26-7.19); 30-80 ml (OR = 12.00;95%CI:7.26-22.53); >80 ml (OR = 30.00;95%CI:15.94-59.09)], female sex (OR = 1.58;95%CI:1.08-2.32) and age (OR = 1.04;95%CI:1.02-1.06) were associated with an increased odds of having an increased CAA probability.

CONCLUSION: We identified a strong association between baseline hematoma volume and an increased probability of CAA in lobar ICH patients on NCCT, indicating that large hematoma volumes alone may contribute to the occurrence of FLP and SAH, and act as a confounder for the simplified Edinburgh CT criteria. Validation against MRI is warranted.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Female, Male, Cerebral Amyloid Angiopathy/diagnostic imaging, Aged, Cerebral Hemorrhage/diagnostic imaging, Tomography, X-Ray Computed/methods, Sweden/epidemiology, Registries, Middle Aged, Probability, Aged, 80 and over
in
Neuroradiology
volume
67
issue
4
pages
823 - 831
publisher
Springer
external identifiers
  • scopus:85218811555
  • pmid:39937267
ISSN
1432-1920
DOI
10.1007/s00234-025-03555-8
language
English
LU publication?
yes
additional info
© 2025. The Author(s).
id
55342256-9b04-41c6-8abf-8d6e926f9c74
date added to LUP
2025-05-27 21:33:35
date last changed
2025-06-11 04:52:57
@article{55342256-9b04-41c6-8abf-8d6e926f9c74,
  abstract     = {{<p>PURPOSE: Early identification of the underlying cause of intracerebral hemorrhage (ICH) is important for treatment and prognosis. This study aims to investigate the association of hematoma volume and other clinical parameters on the distribution of cerebral amyloid angiopathy (CAA) probability according to the simplified Edinburgh CT criteria in a large, unselected intracerebral hemorrhage (ICH) population.</p><p>METHOD: Patients with spontaneous ICH residing in Skane county registered with clinical data in the Swedish Stroke Register 2016-2020 were included. Radiological parameters were evaluated using baseline non-contrast CT (NCCT) for categorization according to the simplified Edinburgh CT criteria by the presence of subarachnoid hemorrhage (SAH) and fingerlike-projections (FLP). Multivariable logistic regression analysis was used to determine factors associated with an increased (intermediate/high) CAA probability.</p><p>RESULTS: Of 666 patients with lobar ICH, 190 (29%) had high, 92 (14%) had intermediate, and 384 (58%) had low CAA probability. Patients with increased CAA probability presented more often with decreased level of consciousness, larger hematoma volumes, and higher 90-day mortality. Baseline hematoma volume [10-30 ml (OR = 4.03;95%CI: 2.26-7.19); 30-80 ml (OR = 12.00;95%CI:7.26-22.53); &gt;80 ml (OR = 30.00;95%CI:15.94-59.09)], female sex (OR = 1.58;95%CI:1.08-2.32) and age (OR = 1.04;95%CI:1.02-1.06) were associated with an increased odds of having an increased CAA probability.</p><p>CONCLUSION: We identified a strong association between baseline hematoma volume and an increased probability of CAA in lobar ICH patients on NCCT, indicating that large hematoma volumes alone may contribute to the occurrence of FLP and SAH, and act as a confounder for the simplified Edinburgh CT criteria. Validation against MRI is warranted.</p>}},
  author       = {{Hillal, Amir and Apostolaki-Hansson, Trine and Ramgren, Birgitta and Hansen, Björn and Norrving, Bo and Wassélius, Johan and Ullberg, Teresa}},
  issn         = {{1432-1920}},
  keywords     = {{Humans; Female; Male; Cerebral Amyloid Angiopathy/diagnostic imaging; Aged; Cerebral Hemorrhage/diagnostic imaging; Tomography, X-Ray Computed/methods; Sweden/epidemiology; Registries; Middle Aged; Probability; Aged, 80 and over}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{823--831}},
  publisher    = {{Springer}},
  series       = {{Neuroradiology}},
  title        = {{The probability of cerebral amyloid angiopathy according to the Simplified Edinburgh CT criteria in a large, unselected lobar intracerebral hemorrhage population}},
  url          = {{http://dx.doi.org/10.1007/s00234-025-03555-8}},
  doi          = {{10.1007/s00234-025-03555-8}},
  volume       = {{67}},
  year         = {{2025}},
}