Topographical Patterns of Intraventricular Hemorrhage as a Novel Prognostic Imaging Biomarker in Intracerebral Hemorrhage.

AIMS: Current intraventricular hemorrhage (IVH) scoring systems quantify individual hemorrhage site features but do not account for differences in overall IVH distribution. We aimed to develop a scoring system based on overall IVH topographical patterns, and evaluate its value for predicting outcomes in intracerebral hemorrhage (ICH). METHODS: We conducted a retrospective analysis of a database including 385 patients with spontaneous ICH, IVH, and hematoma volumes < 40 mL between June 2019 and October 2024. We identified independent predictors of 30-day mortality, evaluated whether IVH spatial features could replace existing IVH scores, developed a novel IVH topographical score (ITS) scoring system, and compared it with four established scoring systems. RESULTS: The IVH topographical patterns demonstrated significantly superior predictive performance for mortality compared with the original and modified Graeb scores. Multivariate analysis identified IVH topographical patterns, hydrocephalus, hematoma volume, and Glasgow Coma Scale score as independent predictors. The ITS demonstrated superior predictive performance for 30-day mortality compared with the other four, including in the external validation cohort (n = 102), while its performance for 6-month outcomes was comparable to the other four. CONCLUSION: Topographical patterns of IVH provide an intuitive tool for risk stratification in patients with IVH. However, larger prospective studies are warranted to validate these findings in broader populations.