Predictive value of maximum hemorrhage area and orthogonal diameter on non-contrast CT for assessing long-term unfavorable functional outcome in intracerebral hemorrhage

Intracerebral hemorrhage (ICH) volume is a primary concern in acute ICH management, as timely prognostic assessment correlates with increased risk of long-term unfavorable functional outcome. This study aimed to evaluate the predictive value of the maximum hemorrhage area (sICH-MaxA) and orthogonal diameters (sICH-OD) on the slice with the largest hemorrhage area on non-contrast computed tomography (NCCT) for long-term (12-month) unfavorable functional outcome in supratentorial spontaneous intracerebral hemorrhage (sICH). A total of 113 patients with supratentorial sICH admitted between June 2022 and June 2024 were enrolled. Patients were categorized into an unfavorable outcome group (modified Rankin Scale score >3, n=41) and a favorable outcome group (modified Rankin Scale score ≤3, n=72). sICH-MaxA and sICH-OD were measured on NCCT and compared with sICH volume. The efficacy of these metrics for assessing long-term unfavorable functional outcome in supratentorial sICH was evaluated. Correlation analysis revealed significant associations between sICH-MaxA, sICH-OD, and sICH volume (r = 0.957 and 0.954, respectively; P < 0.001). The thresholds of sICH-MaxA and sICH-OD for predicting long-term unfavorable outcome were ≥4.705 cm 2 (P < 0.001) and ≥9.255 cm 2 (P < 0.001), respectively. The thresholds for determining the need for surgical intervention were sICH-MaxA >5.56 cm 2 (P < 0.001) and sICH-OD >9.85 cm 2 (P < 0.001). The areas under the curve (AUC) for predicting long-term unfavorable functional outcome were: sICH volume = 0.873, sICH-MaxA = 0.866, sICH-OD = 0.855. sICH-MaxA and sICH-OD measured on NCCT demonstrate predictive value for long-term unfavorable functional outcome in patients with supratentorial sICH.