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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