Blend sign, black hole sign and its combined signs with CT scanning for the predictive value of early hematoma enlargement in patients with intracerebral hemorrhage

Yang Wensong; Li Qi; Wang Xingchen; Li Rui; Zou Ning; Xie Peng

doi:10.3969/j.issn.1672-5921.2017.11.001

Abstract：Objective To investigate the value of blend sign and/or black hole sign with CT scanning for predicting early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods From July 2011 to July 2016,244 consecutive patients with primary intracerebral hemorrhage in the First Affiliated Hospital of Chongqing Medical University were enrolled prospectively.From the onset to the first CT time were all ≤ 6 h.They were randomly divided into either an early hematoma enlargement group (n =82) or a non-hematoma enlargement group (n =162) according to whether they had early hematoma enlargement or not.The general data of patients were collected and compared between the groups,including previous history,clinical features,Glasgow coma scale (GCS) at admission,imaging features (black hole sign,blend sign and black hole sign and/or blend sign),etc.Multivariate logistic regression analysis was performed on the factors influencing early hematoma enlargement.The predictive value of imaging signs of early hematoma enlargement was analyzed.Results (1) In patients with early hematoma enlargement,there were 27 (32.9％) patients had black hole sign,33 (40.2％) had blend sign,and 50(61.0％) had blend sign and/or black hole sign.(2) The volume of hematoma according to 1 ml,the first CT time from onset to admission according to 1 h,and GCS on admission according to 1,the black hole sign and blend sign were included in the multivariate logistic regression analysis.The results showed that both the blend sign (OR,14.04,95％ CI 5.16-38.18) and the black hole sign (OR,5.69,95％ CI 2.12-15.30) were the independent risk factors for early hematoma enlargement (all P ＜ 0.01).After further adjustment,it showed that the blend sign and/or black hole sign were also the independent risk factors for early hematoma enlargement (OR,14.08,95％ CI 5.99-33.08,P ＜0.01).(3) After the analysis of the receiver operating characteristic curve,the sensitivity,specificity,positive predictive value,negative predictive value,and Youden Index of the blend sign and/or black hole sign of predicting early hematoma enlargement were 61.0％,90.1％,76.0％,82.0％,and 0.511,respectively.Its Youden Index was closer to 1 than the black hole sign (Youden Index:0.280) and the blend sign (Youden Index:0.346).Conclusion Compared with the single sign,the blend sign combined with black hole sign has better predictive ability for early hematoma enlargement after intracerebral hemorrhage.