Pensato Umberto, Tanaka Koji, Ospel Johanna M, Aviv Richard I, Rodriguez-Luna David, Hill Micheal D, Molina Carlos A, Silva Blas Yolanda, Boulanger Jean-Martin, Gord Gubitz, Bhatia Rohit, Padma Vasantha, Roy Jayanta, Dzialowski Imanuel, Kase Carlos S, Kobayashi Adam, Dowlatshahi Dar, Demchuk Andrew M
IRCCS Humanitas Research Hospital, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Int J Stroke. 2025 Jul;20(6):721-730. doi: 10.1177/17474930241307466. Epub 2025 Jan 10.
Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast computed tomography (NCCT) hypodensity and computed tomography angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for HE in a single-center cohort. In this analysis, we aimed to validate the predictive accuracy of the B&W sign for HE in a multicenter cohort.
Acute ICH patients from the multicenter, observational PREDICT study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT) were included. Outcomes included HE (⩾6 mL or ⩾33%) and severe HE (⩾12.5 mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors.
Three hundred four patients were included, with 106 (34.9%) showing HE. The spot sign was present in 76 (25%) patients, the hypodensity sign in 119 (39.1%), and the B&W sign in 29 (9.5%). In the stratum with positive spot signs, patients with B&W signs experienced more frequent HE (79.3% vs 46.8%, p = 0.008), hematoma absolute growth (19.1 mL (interquartile range (IQR) = 6.4-40) vs 3.2 mL (IQR= 0-23.3), p = 0.018), and hematoma relative growth (92% (IQR = 16-151%) vs 24% (IQR= 0-69%), p = 0.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR) = 7.83 (95% confidence interval (CI) = 2.93-20.91)) and severe HE (adjusted OR = 5.67 (95% CI = 2.41-13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR = 61.7-90.1) for HE. Inter-rater agreement was moderate (k = 0.54).
The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.
血肿扩大（HE）发生在四分之一至三分之一的急性脑出血（ICH）患者中，且与更差的预后相关。非增强计算机断层扫描（NCCT）低密度区与计算机断层扫描血管造影（CTA）斑点征的共同定位，即所谓的黑白（B&W）征，已被证明在单中心队列中对HE具有较高的预测准确性。在本分析中，我们旨在验证B&W征在多中心队列中对HE的预测准确性。
纳入多中心观察性PREDICT研究（使用对比剂团注CT预测脑出血血肿生长和结局）中的急性ICH患者。结局包括HE（≥6 mL或≥33%）和严重HE（≥12.5 mL或>66%）。通过对基线因素进行调整的多变量回归分析评估B&W征与结局之间的关联。
共纳入304例患者，其中106例（34.9%）出现HE。斑点征出现在76例（25%）患者中，低密度征出现在119例（39.1%）患者中，B&W征出现在29例（9.5%）患者中。在斑点征阳性的亚组中，有B&W征的患者发生HE的频率更高（79.3%对46.8%，p = 0.008），血肿绝对生长量更大（19.1 mL（四分位间距（IQR）= 6.4 - 40）对3.2 mL（IQR = 0 - 23.3），p = 0.018），血肿相对生长量更大（92%（IQR = 16 - 151%）对24%（IQR = 0 - 6管造影（CTA）斑点征的共同定位，即所谓的黑白（B&W）征，已被证明在单中心队列中对HE具有较高的预测准确性。在本分析中，我们旨在验证B&W征在多中心队列中对HE的预测准确性。
纳入多中心观察性PREDICT研究（使用对比剂团注CT预测脑出血血肿生长和结局）中的急性ICH患者。结局包括HE（≥6 mL或≥33%）和严重HE（≥12.5 mL或>66%）。通过对基线因素进行调整的多变量回归分析评估B&W征与结局之间的关联。
共纳入304例患者，其中106例（34.9%）出现HE。斑点征出现在76例（25%）患者中，低密度征出现在119例（39.1%）患者中，B&W征出现在29例（9.5%）患者中。在斑点征阳性的亚组中，有B&W征的患者发生HE的频率更高（79.3%对46.8%，p = 0.008），血肿绝对生长量更大（19.1 mL（四分位间距（IQR）= 6.4 - 40）对3.2 mL（IQR = 0 - 23.3），p = 0.018），血肿相对生长量更大（92%（IQR = 16 - 151%）对24%（IQR = 0 - 69%），p = 0.038）。B&W征与HE（调整后的优势比（OR）= 7.83（95%置信区间（CI）= 2.93 - 20.91））和严重HE（调整后的OR = 5.67（95% CI = 2.41 - 13.36））之间存在强关联。B&W征对HE的阳性预测值为79.3%（IQR = 61.7 - 90.1）。观察者间一致性为中等（k = 0.54）。
B&W征分别与HE和严重HE发生可能性增加约8倍和5倍相关。
