Predictive value of the black hole sign and the island sign for hematoma expansion in patients with acute spontaneous intracerebral hemorrhage
WANG Yu-cai;WANG Hui;ZHANG Mei;Department of Neurology, Beijing Shunyi Hospital;
Objective To explore predictive value of the predictive value of black hole sign and island sign on non-contrast CT in predicting hematoma expansion(HE) in patients with acute spontaneous intracerebral hemorrhage(ICH). Methods One hundred and fifty-six patients with acute spontaneous ICH were examined by non-contrast CT within 6 h after symptom onset, and reexamined at 24 h after onset. The accuracy of two signs in predicting HE was analyzed by ROC. Results Compared with those in non-HE group, there were significant differences in the time-to-admission CT scan, baseline hematoma volume on admission CT, the systolic blood pressure at admission, the presence of black hole sign and island sign in HE group(all P0.01). Multivariate Logistic regression analysis showed that the time-to-admission CT scan, baseline hematoma volume, the systolic blood pressure at admission, black hole sign and island sign were independent risk factors of HE(P0.05-0.01). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and the area under the curve(AUC) of back hole sign for predicting HE were 52.7%, 87.1%, 69.0%, 77.2% and 0.699; the sensitivity, specificity, PPV, NPV and AUC of island sign for predicting HE were 67.3%, 89.1%, 77.1%, 83.3% and 0.782, respectively. The predictive value of island sign for HE was better than that of black hole sign. Conclusions The time-to-admission CT scan, baseline hematoma volume, the systolic blood pressure at admission, black hole sign and island sign are independent risk factors for HE in patients with ICH. Both the black hole sign and island sign appeared to have good predictive value for HE on non-contrast CT, but island sign is a better predictor than black hole sign.
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