Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose Blend sign (BS) and black hole sign (BHS) on non-contrast computed tomography (NCCT) and spot sign (SS) on CT-angiography (CTA) are indicators of early hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, their independent contributions to outcome have not been well explored. Methods In this retrospective study, inclusion criteria were: 1) spontaneous ICH and 2) NCCT and CTA performed on admission within 6 hours after onset of symptoms. Discharge outcome was dichotomized as good (modified Rankin Scale [mRS] 0-3) and poor (mRS 4-6) outcomes. The impacts of BHS, BS and SS on outcome were assessed in univariate and multivariable logistic regression models. Results Of 182 patients with spontaneous ICH, 26 (14.3%) presented with BHS, 37 (20.3%) with BS and 39 (21.4%) with SS. There was a substantial correlation between SS and BS (κ=0.701) and a moderate correlation between SS and BHS (κ=0.424). In univariable logistic regression, higher baseline hematoma volume (P<0.001), intraventricular hemorrhage (P=0.002) and the presence of BHS/BS/SS (all P<0.001) on admission CT scan were associated with poor outcome. Multivariable analysis identified intraventricular haemorrhage (odds ratio [OR] 2.22 per mL, P=0.022), baseline hematoma volume (OR 1.03 per mL, P<0.001) and SS on CTA (OR 11.43, P<0.001) as independent predictors of poor outcome, showing that SS compared to BS and BHS was more powerful to predict poor outcome. Conclusions The NCCT BHS and BS are correlated with the CTA SS and are reliable predictors of poor outcome in patients with ICH. Of the CT variables indicating early hematoma expansion, SS on CTA was the most reliable outcome predictor. However, given their correlation with SS on CTA, BS and BHS on NCCT can be useful for predicting outcome if CTA is not obtainable.
Abstract
Background and Purpose Blend sign (BS) and black hole sign (BHS) on non-contrast computed tomography (NCCT) and spot sign (SS) on CT-angiography (CTA) are indicators of early hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, their independent contributions to outcome have not been well explored. Methods In this retrospective study, inclusion criteria were: 1) spontaneous ICH and 2) NCCT and CTA performed on admission within 6 hours after onset of symptoms. Discharge outcome was dichotomized as good (modified Rankin Scale [mRS] 0-3) and poor (mRS 4-6) outcomes. The impacts of BHS, BS and SS on outcome were assessed in univariate and multivariable logistic regression models. Results Of 182 patients with spontaneous ICH, 26 (14.3%) presented with BHS, 37 (20.3%) with BS and 39 (21.4%) with SS. There was a substantial correlation between SS and BS (κ=0.701) and a moderate correlation between SS and BHS (κ=0.424). In univariable logistic regression, higher baseline hematoma volume (P<0.001), intraventricular hemorrhage (P=0.002) and the presence of BHS/BS/SS (all P<0.001) on admission CT scan were associated with poor outcome. Multivariable analysis identified intraventricular haemorrhage (odds ratio [OR] 2.22 per mL, P=0.022), baseline hematoma volume (OR 1.03 per mL, P<0.001) and SS on CTA (OR 11.43, P<0.001) as independent predictors of poor outcome, showing that SS compared to BS and BHS was more powerful to predict poor outcome. Conclusions The NCCT BHS and BS are correlated with the CTA SS and are reliable predictors of poor outcome in patients with ICH. Of the CT variables indicating early hematoma expansion, SS on CTA was the most reliable outcome predictor. However, given their correlation with SS on CTA, BS and BHS on NCCT can be useful for predicting outcome if CTA is not obtainable.
참고문헌 (13)
- Brott T, "Early hemorrhage growth in patients with intracerebral hemorrhage", Stroke, 28, pp.1~5 (1997)
- Davis SM, "Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage", Neurology, 66, pp.1175~1181 (2006)
- Delcourt C, "Hematoma growth and outcomes in intracerebral hemorrhage:the INTERACT1 study", Neurology, 79, pp.314~319 (2012)
- Fujii Y, "Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage", Stroke, 29, pp.1160~1166 (1998)
- Broderick JP, "Volume of intracerebral hemorrhage. A powerful and easy-touse predictor of 30-day mortality", Stroke, 24, pp.987~993 (1993)
- Li Q, "Blend sign on computed tomography: novel and reliable predictor for early hematoma growth in patients with intracerebral hemorrhage", Stroke, 46, pp.2119~2123 (2015)
- Blacquiere D, "Intracerebral hematoma morphologic appearance on noncontrast computed tomography predicts significant hematoma expansion", Stroke, 46, pp.3111~3116 (2015)
- Li Q, "Black hole sign: novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage", Stroke, 47, pp.1777~1781 (2016)
- Du FZ, "The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage:a systematic review and meta-analysis", PLoS One, 9, pp.e115777~ (2014)
- Del Giudice A, "Accuracy of the spot sign on computed tomography angiography as a predictor of haematoma enlargement after acute spontaneous intracerebral haemorrhage: a systematic review", Cerebrovasc Dis, 37, pp.268~276 (2014)
- Sporns PB, "Computed tomographic blend sign is associated with computed tomographic angiography spot sign and predicts secondary neurological deterioration after intracerebral hemorrhage", Stroke, 48, pp.131~135 (2017)
- Leisenring W, "Comparisons of predictive values of binary medical diagnostic tests for paired designs", Biometrics, 56, pp.345~351 (2000)
- Landis JR, "The measurement of observer agreement for categorical data", Biometrics, 33, pp.159~174 (1977)