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Sex differences in imaging features including cerebral amyloid angiopathy markers in intracerebral hemorrhage

Apostolaki-Hansson, Trine LU orcid ; Kremer, Christine LU ; Hillal, Amir LU orcid ; Carcel, Cheryl ; Ullberg, Teresa LU ; Norrving, Bo LU and Petersson, Jesper LU (2026) In Frontiers in Stroke 5.
Abstract
Background:

Reports on sex differences in radiological characteristics of intracerebral hemorrhage (ICH) are few. Sex-related differences in hematoma location, volume, and imaging markers may contribute to variations in clinical presentation and outcome. We aimed to assess sex differences in non-contrast computed tomography (NCCT) features in an unselected ICH cohort.

Methods:

This observational study included 1,398 patients with spontaneous supratentorial ICH from the Skåne Hospital Region, Sweden (2016–2021), registered in Riksstroke. Radiological characteristics were compared between males and females. Multivariable logistic regression, adjusted for confounders, analyzed sex differences overall and stratified... (More)
Background:

Reports on sex differences in radiological characteristics of intracerebral hemorrhage (ICH) are few. Sex-related differences in hematoma location, volume, and imaging markers may contribute to variations in clinical presentation and outcome. We aimed to assess sex differences in non-contrast computed tomography (NCCT) features in an unselected ICH cohort.

Methods:

This observational study included 1,398 patients with spontaneous supratentorial ICH from the Skåne Hospital Region, Sweden (2016–2021), registered in Riksstroke. Radiological characteristics were compared between males and females. Multivariable logistic regression, adjusted for confounders, analyzed sex differences overall and stratified by hematoma location (deep/lobar). CAA probability was assessed using the simplified Edinburgh CT criteria.

Results:

Among 785 males and 613 females, hematoma volume, location, and antithrombotic use were similar. Women were older (79 vs. 73 years; p < 0.001), more often had severe white matter changes on baseline NCCT, with overall differences in white matter change distribution between sexes (p = 0.006), intraventricular hemorrhage (45.2% vs. 38.7%; p = 0.02), finger-like projections (18.1% vs. 10.6%; p < 0.001), subarachnoid extension (25.1% vs. 15.7%; p < 0.001), and hydrocephalus (16.6% vs. 10.0%; p = 0.001). In lobar ICH (n = 666), high CAA probability was more common in women (28.8% vs. 15.0%, p < 0.001), and in multivariable analysis, female sex was independently associated with subarachnoid extension (OR 1.89 95%CI 1.29–2.77).

Conclusion:

In this large, unselected cohort of supratentorial ICH, no sex differences were observed in hematoma volume, location, or intraventricular extension. However, in lobar ICH, female sex was independently associated with subarachnoid extension and CT features suggestive of higher CAA probability. These findings indicate similar hemorrhage severity between sexes but differences in lobar hemorrhage morphology that require further validation and explanation. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ICH, intracerebral hemorrhage, neuroradiology, sex differences, stroke, subarachnoid extension
in
Frontiers in Stroke
volume
5
pages
9 pages
publisher
Frontiers Media S. A.
ISSN
2813-3056
DOI
10.3389/fstro.2026.1810711
language
English
LU publication?
yes
id
fd6557a1-b459-4dd1-ba16-90f1bc8aac3e
date added to LUP
2026-07-02 11:03:51
date last changed
2026-07-02 17:24:37
@article{fd6557a1-b459-4dd1-ba16-90f1bc8aac3e,
  abstract     = {{Background:<br/><br/>Reports on sex differences in radiological characteristics of intracerebral hemorrhage (ICH) are few. Sex-related differences in hematoma location, volume, and imaging markers may contribute to variations in clinical presentation and outcome. We aimed to assess sex differences in non-contrast computed tomography (NCCT) features in an unselected ICH cohort.<br/><br/>Methods:<br/><br/>This observational study included 1,398 patients with spontaneous supratentorial ICH from the Skåne Hospital Region, Sweden (2016–2021), registered in Riksstroke. Radiological characteristics were compared between males and females. Multivariable logistic regression, adjusted for confounders, analyzed sex differences overall and stratified by hematoma location (deep/lobar). CAA probability was assessed using the simplified Edinburgh CT criteria.<br/><br/>Results:<br/><br/>Among 785 males and 613 females, hematoma volume, location, and antithrombotic use were similar. Women were older (79 vs. 73 years; p &lt; 0.001), more often had severe white matter changes on baseline NCCT, with overall differences in white matter change distribution between sexes (p = 0.006), intraventricular hemorrhage (45.2% vs. 38.7%; p = 0.02), finger-like projections (18.1% vs. 10.6%; p &lt; 0.001), subarachnoid extension (25.1% vs. 15.7%; p &lt; 0.001), and hydrocephalus (16.6% vs. 10.0%; p = 0.001). In lobar ICH (n = 666), high CAA probability was more common in women (28.8% vs. 15.0%, p &lt; 0.001), and in multivariable analysis, female sex was independently associated with subarachnoid extension (OR 1.89 95%CI 1.29–2.77).<br/><br/>Conclusion:<br/><br/>In this large, unselected cohort of supratentorial ICH, no sex differences were observed in hematoma volume, location, or intraventricular extension. However, in lobar ICH, female sex was independently associated with subarachnoid extension and CT features suggestive of higher CAA probability. These findings indicate similar hemorrhage severity between sexes but differences in lobar hemorrhage morphology that require further validation and explanation.}},
  author       = {{Apostolaki-Hansson, Trine and Kremer, Christine and Hillal, Amir and Carcel, Cheryl and Ullberg, Teresa and Norrving, Bo and Petersson, Jesper}},
  issn         = {{2813-3056}},
  keywords     = {{ICH; intracerebral hemorrhage; neuroradiology; sex differences; stroke; subarachnoid extension}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Stroke}},
  title        = {{Sex differences in imaging features including cerebral amyloid angiopathy markers in intracerebral hemorrhage}},
  url          = {{http://dx.doi.org/10.3389/fstro.2026.1810711}},
  doi          = {{10.3389/fstro.2026.1810711}},
  volume       = {{5}},
  year         = {{2026}},
}