Blend Sign Is a Strong Predictor of the Extent of Early Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose: It is unclear which imaging marker is optimal for predicting the extent of hematoma expansion (EHE). We aimed to compare the usefulness of the blend sign (BS) with that of other non-contrast computed tomography (NCCT) markers for predicting the EHE in patients with spontaneous intracerebral hemorrhage (sICH). Methods: Patients with sICH admitted to our Neurology Emergency Department between September 2013 and January 2019 were enrolled. The EHE was calculated as the absolute increase in hematoma volume between baseline and follow-up CT (within 72 h). The EHE was categorized into four groups: "no growth," "minimal change" (≤5.1 ml), "moderate change" (5.1-12.5 ml), and "massive change" (>12.5 ml). Univariate and multivariate analyses were performed to investigate the relationship between the NCCT markers [BS, black hole sign (BHS), satellite sign, and island sign] and the EHE. Results: A total of 1,111 sICH patients were included (median age: 60 years; 66.5% males). Multiple linear regression analysis showed that the presence of the BS and BHS was independently associated with the EHE, after adjusting for confounders (P < 0.001 and P = 0.003, respectively). The presence of the BS and BHS was positively correlated with growth category (r = 0.285 and r = 0.199, both Ps < 0.001). The BS demonstrated a better predictive performance for the EHE than did the BHS [area under the curve (AUC): 0.67 vs. 0.57; both Ps < 0.001]. Conclusions: In patients with acute sICH, the BS showed a better performance in predicting the EHE compared with other NCCT markers. This imaging marker may help identify patients at a high risk of significant hematoma expansion and may facilitate its early management.

A non-contrast computed tomography-based radiomics nomogram for the prediction of hematoma expansion in patients with deep ganglionic intracerebral hemorrhage

“…These markers may reflect a similar pathophysiological process, which is manifested as active hemorrhage secondary to vessel rupture at different time points (37). Blend sign (30,38) and hypodensity (31) have been identified as independent predictors of HE, which is consistent with our results. In previous studies, however, a single sign displayed limitations in predicting HE in clinical settings, as shown by that the blend sign had a low sensitivity, and hypodensity had a low specificity (27,39).…”

Irregular shape as an independent predictor of prognosis in patients with primary intracerebral hemorrhage

“…Qi et al, in a retrospective analysis of 252 patients with intracerebral hemorrhage, showed that the island sign was an independent predictor of hematoma enlargement and poor outcomes in patients with ICH 18 . In a study conducted by Zhang et al 1111 patients with ICH were recruited, and it was found that blend signs could help doctors grade the management of patients with intracerebral hemorrhage at admission 19 . In this study, we also analyzed the performance of different NCCT image markers in predicting poor functional prognosis in patients with cerebral hemorrhage, and the results showed good performance.…”

Irregular Shape as An Independent Predictor of Prognosis in Patients with Primary Intracerebral Hemorrhage

“…Qi et al, in a retrospective analysis of 252 patients with intracerebral hemorrhage, showed that the island sign was an independent predictor of hematoma enlargement and poor outcomes in patients with ICH 18 . In the study conducted by Zhang et al,1111 patients with spontaneous intracerebral hemorrhage(ICH)were recruited, and it was found that blend sign could help doctors to grade the management of patients with intracerebral hemorrhage in admission 19 . In a previous study, Moratti et al established a scoring system to predict instability of the hematoma based on three indicators: presence or absence of the mixed sign, time to the appearance of the mixed sign, and reduction in the density of the hematoma at presentation 20 .…”