Pensato Umberto, Tanaka Koji, Horn MacKenzie, Teleg Ericka, Al Sultan Abdulaziz Sulaiman, Kasickova Linda, Ohara Tomoyuki, Ojha Piyush, Marzoughi Sina, Banerjee Ankur, Kulkarni Girish, Dowlatshahi Dar, Goyal Mayank, Menon Bijoy K, Demchuk Andrew M
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Eur Stroke J. 2025 Mar;10(1):181-189. doi: 10.1177/23969873241271745. Epub 2024 Aug 16.
Existing radiological markers of hematoma expansion (HE) show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE.
Consecutive acute intracerebral hemorrhage patients admitted at Foothills Medical Centre in Calgary, Canada, were included. The Black-&-White sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT. The primary outcome was hematoma expansion (⩾6 mL or ⩾33%). Secondary outcomes included absolute (<3, 3-6, 6-12, ⩾12 mL) and relative (0%, <25%, 25%-50%, 50%-75%, or >75%) hematoma growth scales.
Two-hundred patients were included, with 50 (25%) experiencing HE. Forty-four (22%) showed the spot sign, 69 (34.5%) the hypodensity sign, and 14 (7%) co-localized both as the Black-&-White sign. Those with the Black-&-White sign had higher proportions of HE (100% vs 19.4%, < 0.001), greater absolute hematoma growth (23.37 mL (IQR = 15.41-30.27) vs 0 mL (IQR = 0-2.39), < 0.001) and relative hematoma growth (120% (IQR = 49-192) vs 0% (0-15%), < 0.001). The Black-&-White sign had a specificity of 100% (95%CI = 97.6%-100%), a positive predictive value of 100% (95%CI = 76.8%-100%), and an overall accuracy of 82% (95%CI = 76%-87.1%). Among the 14 patients with the Black-&-White sign, 13 showed an absolute hematoma growth ⩾12 mL, and 10 experienced a HE exceeding 75% of the initial volume. The inter-rater agreement was excellent (kappa coefficient = 0.84).
The Black-&-White sign is a robust predictor of hematoma expansion occurrence and severity, yet further validation is needed to confirm these compelling findings.
现有的血肿扩大（HE）影像学标志物的预测准确性一般。我们旨在研究一种新的影像学标志物，该标志物将非增强CT（NCCT）和CT血管造影（CTA）的结果共同定位，以预测血肿扩大。
纳入加拿大卡尔加里山麓医疗中心收治的连续性急性脑出血患者。黑白征定义为CTA上任何视觉识别的斑点征与相应NCCT上的低密度征共同定位。主要结局是血肿扩大（≥6 mL或≥33%）。次要结局包括绝对（<3、3 - 6、6 - 12、≥12 mL）和相对（0%、<25%、25% - 50%、50% - 75%或>75%）血肿增长规模。
纳入200例患者，其中50例（25%）发生血肿扩大。44例（22%）出现斑点征，69例（34.5%）出现低密度征，14例（7%）两者共同定位为黑白征。有黑白征的患者血肿扩大比例更高（100%对19.4%，<0.001），绝对血肿增长更大（23.37 mL（IQR = 15.41 - 30.27）对0 mL（IQR = 0 - 2.39），<0.001），相对血肿增长也更大（120%（IQR = 49 - 192）对0%（0 - 15%），<0.001）。黑白征的特异性为100%（95%CI = 97.6% - 100%），阳性预测值为100%（95%CI = 76.8% - 100%），总体准确率为82%（95%CI = 76% - 87.1%）。在14例有黑白征的患者中，13例绝对血肿增长≥12 mL，10例血肿扩大超过初始体积的75%. 评分者间一致性良好（kappa系数 = 0.84）。
黑白征是血肿扩大发生和严重程度的有力预测指标，但需要进一步验证以证实这些令人信服的发现。
