Is the hyperdensity areas of the CT blend sign associated with the fresh bleeding in intracerebral hemorrhage?

Abstract

Background and purpose Controversies still exist regarding the mechanism behind the formation of the CT blend sign in intracerebral hemorrhage (ICH). This study was undertaken to observe the relationship between the spot sign and the blend sign to gain insights into the blend sign's formation. Methods We collected patient data, including the spot sign's distribution, clinical information, and radiographic data. Patients were categorized based on the spot sign's location within the blend sign. We divided the cohort into two groups: (1) subjects with spot sign in the relatively hypodensity region of the blend sign(Hypo-spot sign group), (2) subjects with spot sign in the relatively hyperdensity region of blend sign(Hyper-spot sign group). Subsequently, based on hematoma expansion (HE), patients were grouped into either the hematoma expansion group (Expander group) or the no hematoma expansion group (No Expander group). After grouping, we analyzed the relationship between the spot sign and the blend sign, as well as the association between the blend sign and HE. Results A total of 205 patients were included in the study. Among them, 190 patients (92.7%) had the spot sign observed in the Hyper-spot sign group, while 55 patients (7.3%) had the spot sign identified in the Hypo-spot sign group. Significant hematoma growth was observed in 60 patients (29.3%) with HE, of which 59 patients (98.3%) had the spot sign detected in the Hyper-spot sign group, and only 1 patient (1.7%) had the spot sign found in the Hypo-spot sign group. Univariate logistic regression analysis revealed that Hyper-spot sign group (6.305, 1.810–49.072; p < 0.05) was an independent predictor of ICH growth. The sensitivity, specificity, positive predictive value, and negative predictive value of Hyper-spot sign group for predicting hematoma growth were 0.983, 0.096, 0.010, and 0.01, respectively. Conclusions In patients presenting both the blend sign and the spot sign, the spot sign was predominantly found in the denser region of the blend sign, indicating active bleeding in the denser part of the blend sign. Trial registration: ClinicalTrials.gov, NCT05548530. Registered September 21, 2022, Prognostic Analysis of Different Treatment Options for Cerebral Hemorrhage - Full Text View - ClinicalTrials.gov