Quantification of hounsfield unit difference in heterogeneous hematoma predicts poor functional outcomes in acute intracerebral hemorrhage

Heterogeneous hematoma exhibiting a blend sign undergo dynamic changes associated with neurological injury. This study quantified hyperdense and hypodense regions of blend sign on serial non-contrast computed tomography (NCCT) using ITK-SNAP, calculated the mean hounsfield unit (HU) difference (dHU), and evaluated its prognostic value in 261 patients with intracerebral hemorrhage (ICH). All patients underwent baseline CT within 6 h of symptom onset and follow-up CT within 24 h. Logistic regression and ROC analysis showed that a higher dHU was independently associated with secondary neurological deterioration, 30-day mortality, and poor 3-month functional outcomes. A dHU > 3.25 predicted poor prognosis with good specificity (AUC 0.707, P < 0.001). These findings suggest that the dHU of heterogeneous hematoma based on serial CT scans is independently associated with poor outcomes after acute ICH. Trial registration: https://ClinicalTrials.gov , NCT05548530.