Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage.
Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage.
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DOI：
10.5853/jos.2016.02061
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发表时间：
2017-09
影响因子：
8.2
通讯作者：
Hanning U
中科院分区：
文献类型：
--
作者：
Sporns PB;Schwake M;Kemmling A;Minnerup J;Schwindt W;Niederstadt T;Schmidt R;Hanning U
CT平扫混合征（BS）、黑洞征（BHS）和CT血管造影（CTA）斑点征（SS）是自发性脑出血（ICH）早期血肿扩大的标志。然而，它们对成果的独立贡献尚未得到充分探讨。 在这项回顾性研究中，入选标准为：1）自发性ICH和2）症状发作后6小时内入院时进行的NCCT和CTA。出院结局分为良好（改良兰金量表[mRS] 0-3）和不良（mRS 4-6）结局。BHS，BS和SS对结果的影响在单变量和多变量logistic回归模型中进行了评估。 在182例自发性ICH患者中，26例（14.3%）表现为BHS，37例（20.3%）表现为BS，39例（21.4%）表现为SS。SS与BS之间存在显著相关性（κ=0.701），SS与BHS之间存在中度相关性（κ=0.424）。单因素Logistic回归分析显示，高血肿体积（P<0.001）、脑室内出血（P=0.002）和入院CT扫描时存在BHS/BS/SS（P均<0.001）与预后不良相关。多变量分析确定脑室内出血（比值比[OR] 2.22/mL，P=0.022）、基线血肿体积（OR 1.03/mL，P<0.001）和CTA上的SS（OR 11.43，P<0.001）是不良结局的独立预测因子，表明SS与BS和BHS相比更能预测不良结局。 NCCT BHS和BS与CTA SS相关，是ICH患者预后不良的可靠预测因子。在提示早期血肿扩大的CT变量中，CTA上的SS是最可靠的结局预测因子。然而，考虑到它们与CTA上的SS、NCCT上的BS和BHS的相关性，如果无法获得CTA，则可用于预测结局。
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. 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. 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. 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.
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