Department of Neurology, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, China.
Department of Neurology, Yongcheng City People's Hospital, Shangqiu, China.
J Neurol. 2018 Aug;265(8):1883-1890. doi: 10.1007/s00415-018-8932-6. Epub 2018 Jun 15.
The hematoma expansion (HE) is an important risk factor for early neurological deterioration and poor prognosis. In this study, we aimed to compare the black hole sign with other computed tomography (CT) features to predict the HE and the outcome in patients with intracerebral hemorrhage (ICH).
Patients were enrolled within 12 h after stroke attack in the emergency department of Henan Provincial People's Hospital between January 2012 and June 2016. The clinical characters and CT features including the initial CT and the follow-up CT within 48 h were recorded. The outcome was assessed by using the modified Rankin Scale on discharge. Logistic regression analyses were used to investigate whether the factors were the independent predictor of HE and the outcome in patients with ICH. The sensitivity, specificity, positive predictive value, and negative predictive of CT features in predicting HE were calculated.
A total of 185 ICH patients were enrolled, including 70 (37.8%) patients in HE group and 115 (62.2%) patients in non-HE group. There were significant difference in the initial hematoma volume, irregular shape, and CT black hole sign (P = 0.013, 0.006 and P < 0.001) between the two groups. While irregular shape and CT black hole sign were independent predictors for HE, the sensitivity and specificity were 71.45 and 54.78, 51.4 and 81.7%, respectively. Multivariable analysis identified CT black hole sign (P = 0.108) and initial intraventricular hemorrhage expansion (P = 0.214) were not the independent predictors of poor outcome.
CT black hole sign presented the best predictive accuracy of predicting HE in patients with ICH compared to other CT features. However, it was not an independent predictor of poor outcome.
血肿扩大（HE）是早期神经功能恶化和预后不良的重要危险因素。本研究旨在比较黑洞征与其他 CT 特征，以预测脑出血（ICH）患者的 HE 和结局。
本研究纳入 2012 年 1 月至 2016 年 6 月在河南省人民医院急诊科发病 12 小时内的患者。记录患者的临床特征和 CT 特征，包括初始 CT 和 48 小时内的随访 CT。采用改良 Rankin 量表评估出院时的结局。采用 logistic 回归分析探讨这些因素是否为 ICH 患者 HE 和结局的独立预测因素。计算 CT 特征预测 HE 的敏感性、特异性、阳性预测值和阴性预测值。
共纳入 185 例 ICH 患者，其中 70 例（37.8%）为 HE 组，115 例（62.2%）为非 HE 组。两组间初始血肿量、形态不规则和 CT 黑洞征差异有统计学意义（P=0.013、0.006 和 P<0.001）。形态不规则和 CT 黑洞征是 HE 的独立预测因素，其敏感性和特异性分别为 71.45%和 54.78%、51.4%和 81.7%。多变量分析发现 CT 黑洞征（P=0.108）和初始脑室内出血扩展（P=0.214）不是不良结局的独立预测因素。
与其他 CT 特征相比，CT 黑洞征在预测 ICH 患者 HE 方面具有最佳的预测准确性。然而，它不是不良结局的独立预测因素。
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