Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Boulouis, Grégoire; Morotti, Andrea; Brouwers, H. Bart; Charidimou, Andreas; Jessel, Michael J.; Auriel, Eitan; Pontes-Neto, Octávio M.; Ayres, Alison; Vashkevich, Anastasia; Schwab, Kristin; Rosand, Jonathan; Viswanathan, Anand; Gurol, M. Edip; Greenberg, Steven M.; Goldstein, Joshua N.

doi:10.1161/strokeaha.116.014425

Cited by 74 publications

(48 citation statements)

References 24 publications

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“…Although it is well-established that NCCT markers reliably predict hematoma growth in patients in ICH, few studies have investigated their impact on functional outcome. To date, the presence of CT hypodensities, island sign, and swirl sign have been associated with poor outcome in previous reports [16, 28-30]. In our study, we demonstrated that the black hole sign on admission CT scan independently predicts poor outcome in patients with ICH with high specificity.…”

Section: Discussionsupporting

confidence: 70%

“…In a study of 1,029 ICH patients, Boulouis et al [27] proposed 4 subtypes of hypodensities that are independent predictors of hematoma expansion. More recently, Boulouis et al [16] demonstrated that the presence of CT hypodensities is associated poor functional outcome (mRS >3) in patients with ICH. In a recent subgroup analysis of the ATTACH 2 trial, Morotti et al [28] found that NCCT signs reliably identify ICH patients at high risk of hematoma growth.…”

Section: Discussionmentioning

confidence: 99%

“…Outcome was dichotomized as favorable and poor outcome from the 3 month mRS score. Poor outcome was defined as a mRS score of 4–6 according to previous definitions [15, 16]. Hypertension was defined as systolic BP ≥140 mm Hg, or diastolic BP ≥90 mm Hg [17].…”

Section: Methodsmentioning

confidence: 99%

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Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Yang

Chen

et al. 2018

Cerebrovasc Dis

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Background: In spontaneous intracerebral hemorrhage (ICH), black hole sign has been proposed as a promising imaging marker that predicts hematoma expansion in patients with ICH. The aim of our study was to investigate whether admission CT black hole sign predicts hematoma growth in patients with ICH. Methods: From July 2011 till February 2016, patients with spontaneous ICH who underwent baseline CT scan within 6 h of symptoms onset and follow-up CT scan were recruited into the study. The presence of black hole sign on admission non-enhanced CT was independently assessed by 2 readers. The functional outcome was assessed using the modified Rankin Scale (mRS) at 90 days. Univariate and multivariable logistic regression analyses were performed to assess the association between the presence of the black hole sign and functional outcome. Results: A total of 225 patients (67.6% male, mean age 60.3 years) were included in our study. Black hole sign was identified in 32 of 225 (14.2%) patients on admission CT scan. The multivariate logistic regression analysis demonstrated that age, intraventricular hemorrhage, baseline ICH volume, admission Glasgow Coma Scale score, and presence of black hole sign on baseline CT independently predict poor functional outcome at 90 days. There are significantly more patients with a poor functional outcome (defined as mRS ≥4) among patients with black hole sign than those without (84.4 vs. 32.1%, p < 0.001; OR 8.19, p = 0.001). Conclusions: The CT black hole sign independently predicts poor outcome in patients with ICH. Early identification of black hole sign is useful in prognostic stratification and may serve as a potential therapeutic target for anti-expansion clinical trials.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Yang

Chen

et al. 2018

Cerebrovasc Dis

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“…41 ICH patients with unfavorable outcome were more likely to demonstrate hypodensities (48% versus 20%; P<0.0001) in univariable analysis. After adjusting for age, admission Glasgow coma scale, warfarin use, intraventricular hemorrhage, baseline ICH volume, and location, NCCT hypodensities were found to be independently associated with increased risk for unfavorable outcome (OR: 1.70;95%CI: 1.10–2.65;p=0.018).…”

Section: Clinical Implications Of Ncct Biomarkersmentioning

confidence: 95%

Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Boulouis

Morotti

Charidimou

et al. 2017

Stroke

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101

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“…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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Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Cited by 74 publications

References 24 publications

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Black Hole Sign Predicts Poor Outcome in Patients with Intracerebral Hemorrhage

Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion

Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

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