A comparative study of the blend sign and the black hole sign on CT as a predictor of hematoma expansion in spontaneous intracerebral hemorrhage

Li, Ruili; Yang, Mei

doi:10.5582/bst.2017.01283

Cited by 16 publications

(6 citation statements)

References 21 publications

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“…We further retrieved 3 studies from references of relevant studies, and included 23 studies in the final analysis, with data from 10363 patients. 7–29 The study selection process is illustrated in Figure 1. The general characteristics of the studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Arba

Rinaldi

Boulouis

et al. 2021

International Journal of Stroke

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Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

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Section: Resultsmentioning

confidence: 99%

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Arba

Rinaldi

Boulouis

et al. 2021

International Journal of Stroke

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“…The density of hematoma is influenced by their composition, where the hemoglobin content is an important determinant of hematoma density on NCCT images, which shows high density when the blood is clotted and lower density when there is active bleeding, while the mixing of blood at different times leads to the appearance of heterogeneous signs of high and low mixed density (9,10). Heterogeneous signs were positively associated with early HE, poor prognosis, morbidity, and mortality (20). Meta-analysis showed that the black hole sign had a 30% sensitivity and 91% specificity in predicting HE; the blend sign had a sensitivity of 28% and a specificity of 92% in making predictions (21,22).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of spontaneous intracranial basal ganglia hemorrhage and risk factors for hematoma expansion in the plateaus of China

et al. 2023

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Background and purposeThe clinical features of intracranial cerebral hemorrhage (ICH) and the risk factors for hematoma expansion (HE) have been extensively studied. However, few studies have been performed in patients who live on a plateau. The natural habituation and genetic adaptation have resulted in differences in disease characteristics. The purpose of this study was to investigate the differences and consistency of clinical and imaging characteristics of patients in the plateaus of China compared with the plains, and to analyze the risk factors for HE of intracranial hemorrhage in the plateau patients.MethodsFrom January 2020 to August 2022, we undertook a retrospective analysis of 479 patients with first-episode spontaneous intracranial basal ganglia hemorrhage in Tianjin and Xining City. The clinical and radiologic data during hospitalization were analyzed. Univariate and multivariate logistic regression analyzes were used to assess the risk factors for HE.ResultsHE occurred in 31 plateau (36.0%) and 53 plain (24.2%) ICH patients, and HE was more likely to occur in the plateau patients compared with the plain (p = 0.037). The NCCT images of plateau patients also showed heterogeneity of hematoma imaging signs, and the incidence of blend signs (23.3% vs. 11.0%, p = 0.043) and black hole signs (24.4% vs. 13.2%, p = 0.018) was significantly higher than in the plain. Baseline hematoma volume, black hole sign, island sign, blend sign, and PLT and HB level were associated with HE in the plateau. Baseline hematoma volume and the heterogeneity of hematoma imaging signs were independent predictors of HE in both the plain and plateau.ConclusionCompared with the plain, ICH patients in the plateau were more prone to HE. The patients showed the same heterogeneous signs on the NCCT images as in the plain, and also had predictive value for HE.

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“…Many previous studies have attempted to develop methods for the prediction of hematoma expansion in patients with intracerebral hemorrhage. Specific signs such as the blend sign and black hole sign have been used to predict the expansion of hematomas in a cerebral hemorrhage without using contrast media [7, 8, 15, 16]. However, there have been few reports that focused on traumatic hemorrhagic diseases.…”

Section: Discussionmentioning

confidence: 99%

Leakage sign for acute subdural hematoma in clinical treatment

et al. 2018

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Background Acute subdural hematoma (ASDH) is a serious traumatic disease, and predictive methods for hematoma growth are necessary to decide whether emergent operation is necessary. This study aimed to evaluate the incidence of “leakage” using computed tomography angiography (CTA) in patients with ASDH and to identify its prognostic value. Methods Sixty-seven patients with ASDH were examined using CTA (mean age 64.1 ± 20.6 years; 24 men) by analyzing two serial scans (CTA phase and delayed phase). We defined a positive leakage sign as a > 10% increase in Hounsfield units (HU) in the region of interest. Hematoma expansion was determined using plain CT after 24 h in patients who did not undergo emergent surgery. Results Of the 67 patients, conservative therapy was administered to 35 patients; of these patients, 9 showed hematoma expansion, and 8 of these 9 patients (88.9%) showed positive leakage signs. The sensitivity and specificity of leakage signs to hematoma expansion in the no-surgery group were 88.8% and 76.1%, respectively. All positive leakage signs were found within 4.5 h of injury; patients showing negative leakage signs showed a decreased tendency towards hematoma 24 h after injury. Patients presenting with positive leakage signs had poor outcomes. Conclusions The results indicated that the leakage sign is a sensitive predictor of hematoma expansion and poor outcomes in ASDH. If the hematoma is small but leakage sign-positive, strict observation is necessary and aggressive surgery may improve outcomes.

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A comparative study of the blend sign and the black hole sign on CT as a predictor of hematoma expansion in spontaneous intracerebral hemorrhage

Cited by 16 publications

References 21 publications

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

Clinical characteristics of spontaneous intracranial basal ganglia hemorrhage and risk factors for hematoma expansion in the plateaus of China

Leakage sign for acute subdural hematoma in clinical treatment

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