Blend Sign on Computed Tomography

Li, Qi; Zhang, Gang; Huang, Yongle; Dong, Mei-Xue; Lv, Fajin; Xiao, Wei; Chen, Jianjun; Zhang, Lijuan; Qin, Xinyue; Xie, Peng

doi:10.1161/strokeaha.115.009185

Cited by 235 publications

(115 citation statements)

References 27 publications

(31 reference statements)

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“…Prevalence of BS in our study was 20.3% and comparable to other studies 6 and Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of spot sign and blend sign method when compared with goldstandard. Estimates are given in % with exact 95% confidence interval (CI).…”

Section: Discussionsupporting

confidence: 90%

“…The hematoma BS was defined as recently published. 6 In brief, it represents a hematoma with a hyperdense and a hypodense area, which show a well-defined margin that is easily recognized by the naked eye. There should be a difference of at least 18 HU between the 2 regions, and the hypodense area should not be encapsulated by the hyperdense part of the hematoma ( Figure 1).…”

Section: Imaging Analysismentioning

confidence: 99%

“…6 Another parameter predicting increasing hematoma size is the well-established spot sign (SS) visible in computed tomographic angiography (CTA). 7,8 The major advantage of the BS is the visibility in NCCT which offers a greater availability in clinical routine and a much faster and cheaper assessment.…”

mentioning

confidence: 99%

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Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage

Sporns

Schwake

Schmidt

et al. 2017

Stroke

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Background and Purpose-Significant early hematoma growth in patients with intracerebral hemorrhage is an independent predictor of poor functional outcome. Recently, the novel blend sign (BS) has been introduced as a new imaging sign for predicting hematoma growth in noncontrast computed tomography. Another parameter predicting increasing hematoma size is the well-established spot sign (SS) visible in computed tomographic angiography. We, therefore, aimed to clarify the association between established SS and novel BS and their values predicting a secondary neurological deterioration. Methods-Retrospective study inclusion criteria were (1) spontaneous intracerebral hemorrhage confirmed on noncontrast computed tomography and (2) noncontrast computed tomography and computed tomographic angiography performed on admission within 6 hours after onset of symptoms. We defined a binary outcome (secondary neurological deterioration versus no secondary deterioration). As secondary neurological deterioration, we defined (1) early hemicraniectomy under standardized criteria or (2) secondary decrease of Glasgow Coma Scale of >3 points, both within the first 48 hours after symptom onset. Results-Of 182 patients with spontaneous intracerebral hemorrhage, 37 (20.3%) presented with BS and 39 (21.4%) with SS. Of the 81 patients with secondary deterioration, 31 (38.3%) had BS and SS on admission. Multivariable logistic regression analysis identified hematoma volume (odds ratio, 1.07 per mL; P≤0.001), intraventricular hemorrhage (odds ratio, 3.08; P=0.008), and the presence of BS (odds ratio, 11.47; P≤0.001) as independent predictors of neurological deterioration. Conclusions-The BS, which is obtainable in noncontrast computed tomography, shows a high correlation with the computed tomographic angiography SS and is a reliable predictor of secondary neurological deterioration after spontaneous intracerebral hemorrhage.

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Section: Discussionsupporting

confidence: 90%

Section: Imaging Analysismentioning

confidence: 99%

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Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage

Sporns

Schwake

Schmidt

et al. 2017

Stroke

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“…In particular, at the early stage of disease onset, the prognosis is hard to predict. Li et al [8] first proposed a blend sign phenomenon based on the imaging morphology of hematoma in patients with ICH. The hematoma in the acute stage comprised two hematomas with different densities, as revealed by cranial computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

Early-Stage Estimated Value of Blend Sign on the Prognosis of Patients with Intracerebral Hemorrhage

Zhou¹,

Wang²

2018

BioMed Research International

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Background and Purpose This study aimed to explore the relationship between blend sign and prognosis of patients with intracerebral hemorrhage (ICH). Methods Between January 2014 and December 2016, the results of cranial computed tomography imaging within 24 h after the onset of symptoms from 275 patients with ICH were retrospectively analyzed. The patients with or without blend sign were compared to observe and analyze the difference in coagulation function abnormality, rebleeding, mortality, and bad prognosis rates in the early stages. Results Of the 275 patients with ICH, 47 patients had Blend Sign I (17.09%) and 17 patients had Blend Sign II (6.18%). The coagulation function abnormality rate had no statistical difference among Blend Sign I, Blend Sign II, and conventional groups (P > 0.05). In the Blend Sign I group, the rebleeding rate was 4.26%, bad prognosis rate was 25.53%, and mortality rate was 6.38%, which were not statistically significantly different compared with those in the conventional group (P > 0.05). The rebleeding rate in the Blend Sign II group was 47.06%, bad prognosis rate was 82.35%, and mortality rate was 47.06%, which were statistically significantly different compared with those in the conventional and Blend Sign I groups (P < 0.05). Conclusions For the patients associated with Blend Sign I, the prognosis was equivalent to that in the conventional group, with no statistically significant difference. The rebleeding, bad prognosis, and mortality rates were higher in the Blend Sign II group than in the conventional group and deserved more attention.

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“…Furthermore, some specific features of the hemorrhage itself are crucial prognostic factors for hemorrhage expansion and functional outcome. Heterogeneity [11] and hemorrhage presenting with signs such as “spot sign at CT angiography,” [12,13] “black hole sign,” [14] “blend sign” [15], and hematoma sedimentation levels [16] have all been associated with poor outcome. Particularly, an irregularly shaped hemorrhage is a strong predictor of poor functional outcome [11,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

et al. 2017

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Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients.

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Blend Sign on Computed Tomography

Cited by 235 publications

References 27 publications

Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage

Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage

Early-Stage Estimated Value of Blend Sign on the Prognosis of Patients with Intracerebral Hemorrhage

Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

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