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Is the CT Blend Sign Composed of Two Parts of Blood with Different Age?

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Abstract

Background

Blend sign on initial computed tomography (CT) is associated with poor outcome in patients with intracerebral hemorrhage (ICH). However, the mechanisms underlying the blend sign formation are poorly understood. The present study aimed to explore the possible mechanism of the CT blend sign in patients with ICH.

Methods

Seventy healthy rabbits were selected to prepare an ICH model. The animals were assigned to a whole blood group + whole blood group (ww group, 50 rabbits), a whole blood + plasma group (wp group, 10 rabbits) or a whole blood + serum group (ws group, 10 rabbits). The animals of the ww group were allocated to five subgroups based on the interval between the first infusion of blood and the second one. The subgroups included ww 1 h group (with an interval of 1 h), ww 2 h group, ww 3 h group, ww 4 h group and ww 5 h group. The rabbits from each group received first infusion of 0.3 mL of whole blood into the basal ganglia area to form a hematoma. Then, they received a second infusion of the same amount of whole blood, plasma or serum into the brain to form another hematoma adjacent to the first one.

Results

A hematoma with two densities on brain CT could be formed in each group after a second infusion of blood into the brain. A significant difference in CT attenuation values was observed between the hyperattenuation and the hypoattenuation in all the groups. However, only the morphological features of the hematoma in the ww group was in accordance with the CT blend sign observed in humans. The CT attenuation values in the hypodensity area of the ww 4 h group or the ww 5 h group were decreased compared with the ww 1 h group to the ww 3 h group.

Conclusions

The CT blend sign observed in humans might be composed of two parts of blood with different ages. The hypodense area might be blood with older age and the hyperdense area might be new bleeding.

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Acknowledgements

We are grateful for the help provided by the Image Department of the Affiliated Wudang Hospital of Guizhou Medical University in the analysis of computed tomography. We also wish to thank all the postgraduates that were involved in this study for their hard work.

Funding

This research was supported by the Natural Science Foundation of China (81971126/H0906) and the Guizhou Science and Technology Foundation (qiankehe LH(2017)7187). The Funding body did not take part in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Author notes

  1. Guofeng Wu, Qi Li and Zhouping Tang contributed equally to this paper. They are the co-corresponding authors.

Authors and Affiliations

  1. Emergency Department, The First Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China

    Yinghui Li, Siying Ren, Likun Wang, Yuanhong Mao & Guofeng Wu

  2. Department of Neurology, Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Qi Li

  3. Department of Neurology, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Technology and Sciences, Wuhan, China

    Zhouping Tang

Authors
  1. Yinghui Li
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  2. Siying Ren
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  3. Likun Wang
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  4. Yuanhong Mao
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  5. Guofeng Wu
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  6. Qi Li
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  7. Zhouping Tang
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Contributions

GW, ZT and QL conceived the study, participated in the design of the study, coordinated the study and drafted the manuscript. YL, SR and YM conducted the clinical and experimental study and performed the statistical analyses. LW helped to draft the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Guofeng Wu, Qi Li or Zhouping Tang.

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The present study was approved by the Experimental Animal Ethics Committee of Guizhou Medical University.

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Li, Y., Ren, S., Wang, L. et al. Is the CT Blend Sign Composed of Two Parts of Blood with Different Age?. Neurocrit Care 35, 367–378 (2021). https://doi.org/10.1007/s12028-020-01165-1

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  • DOI: https://doi.org/10.1007/s12028-020-01165-1

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