Blend Sign on Computed Tomography Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage
Blend Sign on Computed Tomography Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage
复制标题
DOI：
10.1161/strokeaha.115.009185
复制
发表时间：
2015-08-01
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;Zhang, Gang;Xie, Peng
背景和目的--脑出血患者早期血肿增大并不少见，是功能预后不良的独立预测因子。本研究的目的是报告和验证我们新发现的CT融合征象在预测早期血肿增长中的应用。方法：纳入在症状出现后6小时内接受基线CT扫描的脑出血患者。在基线CT扫描后24小时内进行后续CT扫描。显著的血肿增长被定义为血肿体积增加33%或绝对血肿体积增加12.5毫升。平扫CT平扫的混合征定义为边界清楚的低密度区和高密度区的混合区。通过单因素和多因素Logistic回归分析，评估平扫CT上混合征的出现与早期血肿增长的关系。结果：本研究共纳入172例患者。172例脑出血患者中，29例(16.9%)CT平扫可见混合征。在61例血肿增大的患者中，24例(39.3%)在入院时CT扫描有混合征。观察者之间在识别混合手势方面的一致性在两个读者之间非常好(kappa=0.957)。多因素Logistic回归分析显示，基线CT扫描时间、初始血肿体积和基线CT扫描出现混合征是早期血肿扩大的独立预测因素。混合征预测血肿生长的敏感度为39.3%，特异度为95.5%，阳性预测值为82.7%，阴性预测值为74.1%。
Background and Purpose-Early hematoma growth is not uncommon in patients with intracerebral hemorrhage and is an independent predictor of poor functional outcome. The purpose of our study was to report and validate the use of our newly identified computed tomographic (CT) blend sign in predicting early hematoma growth.Methods-Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Significant hematoma growth was defined as an increase in hematoma volume of >33% or an absolute increase of hematoma volume of >12.5 mL. The blend sign on admission nonenhanced CT was defined as blending of hypoattenuating area and hyperattenuating region with a well-defined margin. Univariate and multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on nonenhanced admission CT and early hematoma growth.Results-A total of 172 patients were included in our study. Blend sign was observed in 29 of 172 (16.9%) patients with intracerebral hemorrhage on baseline nonenhanced CT scan. Of the 61 patients with hematoma growth, 24 (39.3%) had blend sign on admission CT scan. Interobserver agreement for identifying blend sign was excellent between the 2 readers (kappa=0.957). The multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and presence of blend sign on baseline CT scan to be independent predictors of early hematoma growth. The sensitivity, specificity, positive and negative predictive values of blend sign for predicting hematoma growth were 39.3%, 95.5%, 82.7%, and 74.1%, respectively.Conclusions-The CT blend sign could be easily identified on regular nonenhanced CT and is highly specific for predicting hematoma growth.