Island Sign An Imaging Predictor for Early Hematoma Expansion and Poor Outcome in Patients With Intracerebral Hemorrhage
Island Sign An Imaging Predictor for Early Hematoma Expansion and Poor Outcome in Patients With Intracerebral Hemorrhage
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岛征：脑出血患者早期血肿扩大和不良预后的一种影像学预测指标
DOI：
10.1161/strokeaha.117.017985
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发表时间：
2017-11-01
期刊：
影响因子：
8.3
通讯作者：
Xie, Peng
中科院分区：
文献类型：
--
作者：
Li, Qi;Liu, Qing-Jun;Xie, Peng
背景和目的-本研究的目的是探讨计算机断层扫描（CT）岛征预测早期血肿生长和功能不良outcome.Methods-We纳入自发性脑出血（ICH）患者，这些患者在2011年7月至2016年9月期间在我院ICH症状发作后6小时内接受了基线CT检查。两名阅片者独立评估了入院时非增强CT扫描中岛状征的存在。多变量logistic回归分析被用来分析之间的关联存在的岛屿迹象，入院CT平扫和早期血肿生长和功能outcome.Results-A共252例符合纳入标准进行了分析。其中，41例（16.3%）患者在基线平扫CT扫描时出现岛状征。此外，在85例血肿生长患者中的38例（44.7%）中观察到岛状征。多变量logistic回归分析表明，基线CT扫描时间、初始血肿体积和基线CT扫描出现岛状征独立预测早期血肿生长。岛状征预测血肿扩大的敏感性为44.7%，特异性为98.2%，阳性预测值为92.7%，阴性预测值为77.7%。在调整患者的年龄、基线格拉斯哥昏迷评分、脑室内出血、蛛网膜下腔出血、入院时收缩压、基线ICH体积和幕下位置后，岛状征的存在（比值比，3.51; 95%可信区间，1.26-9.81; P=0.017）仍然是ICH患者预后不良的独立预测因素。岛状征是一种可靠的CT影像学标记，可独立预测ICH患者的血肿扩大和不良结局。CT平扫岛状征可作为介入治疗的潜在标志。
Background and Purpose-The aim of the study was to investigate the usefulness of the computed tomography (CT) island sign for predicting early hematoma growth and poor functional outcome.Methods-We included patients with spontaneous intracerebral hemorrhage (ICH) who had undergone baseline CT within 6 hours after ICH symptom onset in our hospital between July 2011 and September 2016. Two readers independently assessed the presence of the island sign on the admission noncontrast CT scan. Multivariable logistic regression analysis was used to analyze the association between the presence of the island sign on noncontrast admission CT and early hematoma growth and functional outcome.Results-A total of 252 patients who met the inclusion criteria were analyzed. Among them, 41 (16.3%) patients had the island sign on baseline noncontrast CT scans. In addition, the island sign was observed in 38 of 85 patients (44.7%) with hematoma growth. Multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and the presence of the island sign on baseline CT scan independently predicted early hematoma growth. The sensitivity of the island sign for predicting hematoma expansion was 44.7%, specificity 98.2%, positive predictive value 92.7%, and negative predictive value 77.7%. After adjusting for the patients' age, baseline Glasgow Coma Scale score, presence of intraventricular hemorrhage, presence of subarachnoid hemorrhage, admission systolic blood pressure, baseline ICH volume, and infratentorial location, the presence of the island sign (odds ratio, 3.51; 95% confidence interval, 1.26-9.81; P=0.017) remained an independent predictor of poor outcome in patients with ICH.Conclusions-The island sign is a reliable CT imaging marker that independently predicts hematoma expansion and poor outcome in patients with ICH. The noncontrast CT island sign may serve as a potential marker for therapeutic intervention.