Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage

Abstract

Background and Purpose-Significant early hematoma growth in patients with intracerebral hemorrhage is an independent predictor of poor functional outcome. Recently, the novel blend sign (BS) has been introduced as a new imaging sign for predicting hematoma growth in noncontrast computed tomography. Another parameter predicting increasing hematoma size is the well-established spot sign (SS) visible in computed tomographic angiography. We, therefore, aimed to clarify the association between established SS and novel BS and their values predicting a secondary neurological deterioration. Methods-Retrospective study inclusion criteria were (1) spontaneous intracerebral hemorrhage confirmed on noncontrast computed tomography and (2) noncontrast computed tomography and computed tomographic angiography performed on admission within 6 hours after onset of symptoms. We defined a binary outcome (secondary neurological deterioration versus no secondary deterioration). As secondary neurological deterioration, we defined (1) early hemicraniectomy under standardized criteria or (2) secondary decrease of Glasgow Coma Scale of >3 points, both within the first 48 hours after symptom onset. Results-Of 182 patients with spontaneous intracerebral hemorrhage, 37 (20.3%) presented with BS and 39 (21.4%) with SS. Of the 81 patients with secondary deterioration, 31 (38.3%) had BS and SS on admission. Multivariable logistic regression analysis identified hematoma volume (odds ratio, 1.07 per mL; P≤0.001), intraventricular hemorrhage (odds ratio, 3.08; P=0.008), and the presence of BS (odds ratio, 11.47; P≤0.001) as independent predictors of neurological deterioration. Conclusions-The BS, which is obtainable in noncontrast computed tomography, shows a high correlation with the computed tomographic angiography SS and is a reliable predictor of secondary neurological deterioration after spontaneous intracerebral hemorrhage.

Early-Stage Estimated Value of Blend Sign on the Prognosis of Patients with Intracerebral Hemorrhage

“…Of the 275 patients with ICH, 47 had Blend Sign I (16.85%), consistent with the findings of Li et al (16.9%) [8] and Sporns et al (20.3% 37/182) [11]. However, only 17 patients had Blend Sign II (6.09%).…”

Inter- and Intrarater Agreement of Spot Sign and Noncontrast CT Markers for Early Intracerebral Hemorrhage Expansion

“…The imaging sign HD was defined as any hypodense region strictly encapsulated within the hemorrhage with any shape, size, and density which does not require a density measurement [6,15,22]. The spot sign on CTA was well-acknowledged as the foci of enhancement within the intracranial hematoma, detected on CTA source images [23,24].…”

Correlation between Spot Sign and Intracranial Hemorrhage Expansion on Dual-Phase CT Angiography

“…The results of other studies [21] have suggested that CT variables indicating early hematoma expansion, such as spot sign on CTA, are the most reliable predictors of outcome. Also, a spot sign had a higher sensitivity for predicting outcome than did black hole sign in any location (34.6% vs. 23.1%) [22].…”

“…Early CT protocols in patients with ICH used only NCCT or CTA after NCCT for evaluation of critical imaging findings of ICH expansion [19]. Subsequent papers reported the relationship between imaging findings of CTA and NCCT and ICH expansion [20][21][22]. The study of Sporns et al [20] found that NCCT imaging markers were strongly correlated with an established spot sign.…”