A clinical-radiomics nomogram may provide a personalized 90-day functional outcome assessment for spontaneous intracerebral hemorrhage.

To develop and validate a noncontrast computed tomography (NCCT)–based clinical-radiomics nomogram to identify spontaneous intracerebral hemorrhage (sICH) patients with a poor 90-day prognosis on admission. In this double-center retrospective study, data from 435 patients with sICH (training cohort: n = 244; internal validation cohort: n = 104; external validation cohort: n = 87) were reviewed. The radiomics score (Rad-score) was calculated based on the coefficients of the selected radiomics features. A clinical-radiomics nomogram was developed by using independent predictors of poor outcome at 90 days through multivariate logistic regression analysis in the training cohort and was validated in the internal and external cohorts. At 90 days, 200 of 435 (46.0%) patients had a poor prognosis. The clinical-radiomics nomogram was developed by six independent predictors namely midline shift, NCCT time from sICH onset, Glasgow Coma Scale score, serum glucose, uric acid, and Rad-score. In identifying patients with poor prognosis, the clinical-radiomics nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.81 in the training cohort, an AUC of 0.78 in the internal validation cohort, and an AUC of 0.73 in the external validation cohort. The calibration curve revealed that the clinical-radiomics nomogram showed satisfactory calibration in the training and internal validation cohorts (both p > 0.05), but slightly poor agreement in the external validation cohort (p < 0.05). The clinical-radiomics nomogram is a valid computer-aided tool that may provide personalized risk assessment of 90-day functional outcome for sICH patients. • The proposed Rad-score was significantly associated with 90-day poor functional outcome in patients with sICH. • The clinical-radiomics nomogram showed satisfactory calibration and the most net benefit for discriminating 90-day poor outcome. • The clinical-radiomics nomogram may provide personalized risk assessment of 90-day functional outcome for sICH patients.