Radiological markers in spontaneous intracerebral haemorrhage: A retrospective validation of the Hematoma Maturity Score

Abstract

Purpose

To validate the combined marker Hematoma Maturity Score (HMS) in non-contrast computed tomography (NCCT) scans of patients with spontaneous intracerebral hematomas (ICH) for predicting functional outcomes at discharge, compared to individual radiological signs.

Methods

A retrospective analysis of clinical and imaging data was conducted for patients with spontaneous ICH who underwent NCCT within the first 24 h. The Black Hole Sign, Blend sign, Island Sign, Swirl Sign, and HMS were independently assessed by two radiologists, a first-year neuroradiology fellow, and a neuroradiologist with 16 years of experience. Patients were grou-ped based on discharge dependency according to the Modified Rankin Scale (mRS) score: no/mild disability (0–2); moderate/severe disability (3–5); and mortality (6).

Results

Sixty-four patients with spontaneous ICH were included. There was almost perfect agreement between readers regarding HMS scoring (kappa = 0.86) and substantial to moderate agreement for the remaining signs. Multivariable statistical analysis was adjusted for antiplate-let therapy, hematoma volume, ventricular expansion, blood glucose, age, and sex. Immature HMS (OR 15.966, p = 0.044) was an independent predictor of functional outcome at discharge, while the other signs did not yield significant results.

Conclusions

HMS is a prognostic biomarker easily assessable in NCCT, serving as a valuable tool for guiding clinical decision-making and workflow management in therapeutic trials. © 2025 SERAM. Published by Elsevier Espa˜na, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.