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Small Intracerebral Hemorrhage: Baseline CT Edema-to-Hematoma Ratio as an Independent Predictor of Early Expansion

BACKGROUND AND PURPOSE: Small intracerebral hemorrhage (ICH), defined as baseline NCCT hematoma volume (HV) <30 mL, is often considered lower risk for early expansion. We tested whether the edema-to-hematoma ratio (EHR) on baseline NCCT independently predicts expansion and whether combining EHR with HV enables practical bedside risk stratification. MATERIALS AND METHODS: We retrospectively analyzed 219 conservatively managed patients with small-volume ICH. Baseline NCCT underwent artificial intelligence–assisted 3D volumetry to quantify HV and perihematomal edema and to compute EHR. The primary outcome was binary early hematoma expansion on the first follow-up CT. Multivariable logistic regression included HV, EHR, age, deep location, intraventricular hemorrhage, and anticoagulation status. Discrimination and calibration were assessed with 5-fold cross-validation. Youden index cut-points were used to derive a simple bedside rule combining HV and EHR. RESULTS: Early expansion occurred in 20.1% (44/219). Lower EHR and larger HV independently predicted expansion. Per 0.10 increase in EHR, adjusted odds decreased by 23% (adjusted OR [aOR], 0.77; 95% CI, 0.66–0.88); per additional 5 mL in HV, odds increased by 37% (aOR, 1.37; 95% CI, 1.09–1.73). A bedside rule (HV ≥9.2 mL plus EHR ≤0.683) identified a high-risk phenotype with a 39.3% expansion rate vs 4.4% in the low-risk reference. The multivariable model outperformed either predictor alone (area under the curve, 0.748 vs 0.700 and 0.672) with acceptable calibration (intercept, −0.17; slope, 0.92; Brier score, 0.141). CONCLUSIONS: A lower baseline EHR independently predicts early expansion in small-volume ICH. Pairing EHR with HV yields a practical bedside rule with a large risk gradient and improves discrimination beyond volume alone, supporting targeted monitoring and timely repeat imaging. aOR : adjusted OR AI : artificial intelligence AUROC : area under the receiver operating characteristic curve EHR : edema-to-hematoma ratio HE : hematoma expansion HV : hematoma volume ICH : intracerebral hemorrhage IQR : interquartile range IVH : intraventricular hemorrhage PHE : perihematomal edema ROC : receiver operating characteristic

www.ajnrclinicalpractice.org

Pediatric Ocular Abnormalities: A Pictorial Review of Genetic, Metabolic, and Syndromic Associations. Part 1: Abnormalities of the Globe and Lens

SUMMARY: This 2-part pictorial review illustrates the spectrum of ocular abnormalities in pediatric imaging and highlights their diagnostic and prognostic implications. Part 1 focuses on globe and lens abnormalities, including the microphthalmos-anophthalmos-coloboma (MAC) complex, macrophthalmos, congenital cataracts, and lens dislocation. Part 2 covers posterior segment and optic pathway abnormalities, ranging from persistent fetal vasculature to optic nerve pathologies. Selected cases demonstrate key associated brain and spine imaging features, syndromic associations, and prognostic significance, showing how orbital imaging can guide targeted genetic testing, improve diagnostic accuracy, and differentiate overlapping conditions. By systematically evaluating the orbits on pediatric brain MRI, radiologists can identify genetic disorders and syndromes early, support clinical and genetic assessment, and improve patient care. CHARGE : coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and/or development, genital and/or urinary abnormalities, and ear abnormalities and deafness CIMDAG : cerebellar hypoplasia and cataracts, intellectual disability, congenital microcephaly, dystonia and dyserythropoietic anemia, and growth retardation CS : Cockayne syndrome COACH syndrome : cerebellar vermis hypoplasia, oligophrenia, ataxia, coloboma, hepatic fibrosis ECCL : encephalocraniocutaneous lipomatosis FCMD : Fukuyama congenital muscular dystrophy JS : Joubert syndrome MAC : microphthalmos-anophthalmos-coloboma MEB : muscle-eye-brain disease MGDA : morning glory disc anomaly OAVS : oculo-auriculo-vertebral spectrum OCCS : oculocerebrocutaneous syndrome PBS : Poretti-Boltshauser syndrome TORCH : toxoplasmosis, other agents (such as HIV, syphilis, and Zika), rubella, cytomegalovirus, and herpes simplex virus WMS : Weill-Marchesani syndrome WWS : Walker-Warburg syndrome