Taha ASLAN, Mohamed ALSHAMRANI, Michael HILL
Turkish Journal of Cerebrovascular Diseases - 2026;32(1):1-9
Hematoma expansion (He) is defined as an increase in intracerebral hemorrhage volume on serial neuroimaging during the acute phase and occurs in approximately 20% of patients with spontaneous intracerebral hemorrhage (ICH). He is associated with early neurological deterioration and worse functional outcome and has therefore been studied as a potential therapeutic target. Identification of patients at higher risk of expansion may inform clinical monitoring strategies and the design of interventional trials. This narrative review summarizes imaging markers that have been evaluated for predicting He , with emphasis on noncontrast computed tomography (NCCT) signs described over the past decade. we review commonly used definitions of He and the pathophysiological rationale underlying density-based markers (hypodensities, blend sign, black hole sign, swirl sign) and shape-based markers (island sign, satellite sign, irregular hematoma shape), as well as the CT angiography spot sign. we also outline integrated prediction models and emerging approaches using radiomics and machine-learning techniques.
