cs.CVOct 26, 2026

Regional prediction of hematoma expansion from non-contrast computed tomography in spontaneous intracerebral hemorrhage patients

Authors: Natasha Ironside, Hongyu Kan, Kristofor Pas, Mohammad Shifat-E-Rabbi, Benjamin Newman, Shinjini Kundu, Kareem El Naamani, Tanvir Rizvi, 

Organizations: Department of Neurological Surgery, University of Illinois Chicago, Chicago, Il · Department of Electrical and Computer Engineering, George Washington University, Washington, DC · Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA · Department of Electrical and Computer Engineering, North South University, Dhaka, Bangladesh · 

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Abstract

Background The combination of hematoma location, expansion and final volume influence neurological outcome. The aim of this study was to derive and validate a quantitative and interpretable region-based NCCT image feature model for predicting hematoma expansion. Methods The Ethnic/Racial Variations of Intracerebral Hemorrhage(ERICH) study was used for derivation and the Virtual International Trials in Stroke Archive(VISTA) was used for validation. NCCT images at presentation and 24+/-6hours were pre-processed, segmented and categorized into lobar, basal ganglia or thalamic regions. Hematoma expansion was defined by region and according to its effect on clinical outcome. Transport-based morphometry (TBM) produced a unique transport-based representation from each NCCT hematoma image. Linear classifiers applied to transport representations were used to derive a predictive model. The regional TBM model's performance was compared to alternate methods using AUROC analyses. Results The derivation dataset included 574 patients, comprising 162 lobar, 257 basal ganglia and 155 thalamic hematomas. The validation dataset included 196 patients, comprising 31 lobar, 119 basal ganglia and 46 thalamic hematomas. A combined regional model predicted hematoma expansion in the validation dataset with an AUROC of 0.787. The principal image features which varied by location were size, heterogeneity, eccentricity and density distribution towards the hematoma periphery. The regional TBM model outperformed alternative clinician based and machine-learning methods. Conclusions TBM discriminated and visualized regional features of hematoma expansion from presentation NCCT scans. This provides preliminary evidence for regional radiographic features of hematoma expansion. It has the potential to improve hematoma expansion prediction and understanding of hematoma expansion pathophysiology.

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Hematoma expansion (HE) after spontaneous intracerebral hemorrhage (ICH) is a major determinant of acute triage and treatment decisions in neurosurgical care. However, most existing methods provide either a binary expansion risk or a single follow-up volume, limiting uncertainty-aware decisions. We introduce HemExp, a clinically-guided latent diffusion model that generates patient-specific follow-up non-contrast CT images, along with segmentations of intraparenchymal and intraventricular hemorrhage. Generation is conditioned on baseline imaging, clinical variables, and an explicit expansion indicator, enabling controllable simulation of realistic clinical scenarios. HemExp uses a hemorrhage-aware multi-head variational autoencoder and models progression as the difference between baseline and follow-up latent representations with a conditional diffusion model. The model is trained on paired scans from 450 patients across multiple centers and evaluated on 107 patients from a held-out institution. HemExp produces spatial HE probability maps by generating multiple synthetic follow-up images per patient to estimate distributions of plausible follow-up hematoma volumes. Perturbing clinical inputs such as symptom-onset-to-imaging time or anticoagulant status shifts the predicted follow-up volume distribution. HemExp extends binary predictors and demonstrates robust estimation of clinically relevant outcomes in the imaging space, such as hematoma volume, intraventricular involvement, and mass effects. Overall, our results support controllable latent diffusion as a promising direction for uncertainty-aware modeling of early ICH progression.

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Sep 17, 2026

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Intrathecal contrast-enhanced MRI shows how a tracer injected into the cerebrospinal fluid spreads through the brain, but requires repeated scans over 24--48,h. We therefore ask how much of the later tracer distribution can be predicted from the pre-contrast scan and elapsed time alone. Using 104 training patients (878 MRI volumes), we compared a direct image-to-image regression model with a more complex generative model based on conditional flow matching, and tested both on 23 held-out patients and on 51 patients from a separate cohort with idiopathic normal pressure hydrocephalus (INPH). The direct model reduced the error of simply copying the pre-contrast scan by about 60% in held-out patients and 25% in the INPH cohort, and its predicted change maps agreed with the observed tracer enhancement rather than only reproducing anatomy. The generative model was less accurate in both cohorts. A substantial part of the later tracer distribution is therefore predictable from the patient's brain anatomy as seen on pre-contrast MRI, and the added model complexity gave no benefit at this data scale. With prospective validation, such forecasts could be studied for patient stratification and treatment planning in intrathecal therapies.

Qinghui Liu, Jon André Ottesen, Thu Nguyen +6

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