Advertisement

Neurological Sciences

, Volume 38, Issue 9, pp 1591–1597 | Cite as

The predictive accuracy of the black hole sign and the spot sign for hematoma expansion in patients with spontaneous intracerebral hemorrhage

  • Zhiyuan Yu
  • Jun Zheng
  • Lu Ma
  • Rui Guo
  • Mou Li
  • Xiaoze Wang
  • Sen Lin
  • Hao Li
  • Chao YouEmail author
Original Article

Abstract

In patients with spontaneous intracerebral hemorrhage (sICH), hematoma expansion (HE) is associated with poor outcome. Spot sign and black hole sign are neuroimaging predictors for HE. This study was aimed to compare the predictive value of two signs for HE. Within 6 h after onset of sICH, patients were screened for the computed tomography angiography spot sign and the non-contrast computed tomography black hole sign. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of two signs for HE prediction were calculated. The accuracy of two signs in predicting HE was analyzed by receiver-operator analysis. A total of 129 patients were included in this study. Spot sign was identified in 30 (23.3%) patients and black hole sign in 29 (22.5%) patients, respectively. Of 32 patients with HE, spot sign was observed in 19 (59.4%) and black hole sign was found in 14 (43.8%). The occurrence of black hole sign was significantly associated with spot sign (P < 0.001). The sensitivity, specificity, PPV, and NPV of spot sign for predicting HE were 59.38, 88.66, 63.33, and 86.87% respectively. In contrast, the sensitivity, specificity, PPV, and NPV of black hole sign for predicting HE were 43.75, 84.54, 48.28, and 82.00%, respectively. The area under the curve was 0.740 for spot sign and 0.641 for black hole sign. (P = 0.228) Both spot sign and black hole sign appeared to have good predictive value for HE, and spot sign seemed to be a better predictor.

Keywords

Black hole sign Hematoma expansion Spontaneous intracerebral hemorrhage Spot sign 

Notes

Acknowledgements

Our great acknowledgement goes to the patients included in this study to make this study possible.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

References

  1. 1.
    Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001) Spontaneous intracerebral hemorrhage. N Engl J med 344(19):1450–1460. doi: 10.1056/nejm200105103441907 CrossRefPubMedGoogle Scholar
  2. 2.
    Yang G, Shao GF (2016) Elevated serum IL-11, TNF alpha, and VEGF expressions contribute to the pathophysiology of hypertensive intracerebral hemorrhage (HICH). Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 37(8):1253–1259. doi: 10.1007/s10072-016-2576-z CrossRefGoogle Scholar
  3. 3.
    Tan G, Hao Z, Lei C, Chen Y, Yuan R, Xu M, Liu M (2016) Subclinical change of liver function could also provide a clue on prognosis for patients with spontaneous intracerebral hemorrhage. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 37(10):1693–1700. doi: 10.1007/s10072-016-2656-0 CrossRefGoogle Scholar
  4. 4.
    Guan J, Hawryluk GW (2016) Targeting secondary hematoma expansion in spontaneous intracerebral hemorrhage—state of the art. Front Neurol 7:187. doi: 10.3389/fneur.2016.00187 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Blacquiere D, Demchuk AM, Al-Hazzaa M, Deshpande A, Petrcich W, Aviv RI, Rodriguez-Luna D, Molina CA, Silva Blas Y, Dzialowski I, Czlonkowska A, Boulanger JM, Lum C, Gubitz G, Padma V, Roy J, Kase CS, Bhatia R, Hill MD, Dowlatshahi D (2015) Intracerebral hematoma morphologic appearance on noncontrast computed tomography predicts significant hematoma expansion. Stroke; a Journal of Cerebral Circulation 46(11):3111–3116. doi: 10.1161/strokeaha.115.010566 CrossRefGoogle Scholar
  6. 6.
    Orito K, Hirohata M, Nakamura Y, Takeshige N, Aoki T, Hattori G, Sakata K, Abe T, Uchiyama Y, Sakamoto T, Morioka M (2016) Leakage sign for primary intracerebral hemorrhage: a novel predictor of hematoma growth. Stroke; a Journal of Cerebral Circulation 47(4):958–963. doi: 10.1161/strokeaha.115.011578 CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Li Q, Zhang G, Huang YJ, Dong MX, Lv FJ, Wei X, Chen JJ, Zhang LJ, Qin XY, Xie P (2015) Blend sign on computed tomography: novel and reliable predictor for early hematoma growth in patients with intracerebral hemorrhage. Stroke; a Journal of Cerebral Circulation 46(8):2119–2123. doi: 10.1161/strokeaha.115.009185 CrossRefGoogle Scholar
  8. 8.
    Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, Symons SP (2007) CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke; a Journal of Cerebral Circulation 38(4):1257–1262. doi: 10.1161/01.STR.0000259633.59404.f3 CrossRefGoogle Scholar
  9. 9.
    Brouwers HB, Falcone GJ, McNamara KA, Ayres AM, Oleinik A, Schwab K, Romero JM, Viswanathan A, Greenberg SM, Rosand J, Goldstein JN (2012) CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage. Neurocrit Care 17(3):421–428. doi: 10.1007/s12028-012-9765-2 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Blas YS, Dzialowski I, Kobayashi A, Boulanger JM, Lum C, Gubitz G, Padma V, Roy J, Kase CS, Kosior J, Bhatia R, Tymchuk S, Subramaniam S, Gladstone DJ, Hill MD, Aviv RI (2012) Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. The Lancet Neurology 11(4):307–314. doi: 10.1016/s1474-4422(12)70038-8 CrossRefPubMedGoogle Scholar
  11. 11.
    Ciura VA, Brouwers HB, Pizzolato R, Ortiz CJ, Rosand J, Goldstein JN, Greenberg SM, Pomerantz SR, Gonzalez RG, Romero JM (2014) Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study. Stroke; a Journal of Cerebral Circulation 45(11):3293–3297. doi: 10.1161/strokeaha.114.005570 CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Du FZ, Jiang R, Gu M, He C, Guan J (2014) The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage: a systematic review and meta-analysis. PLoS One 9(12):e115777. doi: 10.1371/journal.pone.0115777 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Han JH, Lee JM, Koh EJ, Choi HY (2014) The spot sign predicts hematoma expansion, outcome, and mortality in patients with primary intracerebral hemorrhage. Journal of Korean Neurosurgical Society 56(4):303–309. doi: 10.3340/jkns.2014.56.4.303 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Morotti A, Jessel MJ, Brouwers HB, Falcone GJ, Schwab K, Ayres AM, Vashkevich A, Anderson CD, Viswanathan A, Greenberg SM, Gurol ME, Romero JM, Rosand J, Goldstein JN (2016) CT angiography spot sign, hematoma expansion, and outcome in primary pontine intracerebral hemorrhage. Neurocrit Care 25(1):79–85. doi: 10.1007/s12028-016-0241-2 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Li Q, Zhang G, Xiong X, Wang XC, Yang WS, Li KW, Wei X, Xie P (2016) Black hole sign: novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage. Stroke; a Journal of Cerebral Circulation 47(7):1777–1781. doi: 10.1161/strokeaha.116.013186 CrossRefGoogle Scholar
  16. 16.
    Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M (2014) European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. International Journal of Stroke : Official Journal of the International Stroke Society 9(7):840–855. doi: 10.1111/ijs.12309 CrossRefGoogle Scholar
  17. 17.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a Journal of Cerebral Circulation 46(7):2032–2060. doi: 10.1161/str.0000000000000069 CrossRefGoogle Scholar
  18. 18.
    Brouwers HB, Goldstein JN, Romero JM, Rosand J (2012) Clinical applications of the computed tomography angiography spot sign in acute intracerebral hemorrhage: a review. Stroke; a Journal of Cerebral Circulation 43(12):3427–3432. doi: 10.1161/strokeaha.112.664003 CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Delgado Almandoz JE, Yoo AJ, Stone MJ, Schaefer PW, Goldstein JN, Rosand J, Oleinik A, Lev MH, Gonzalez RG, Romero JM (2009) Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score. Stroke; a Journal of Cerebral Circulation 40(9):2994–3000. doi: 10.1161/strokeaha.109.554667 CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke; a Journal of Cerebral Circulation 27(8):1304–1305CrossRefGoogle Scholar
  21. 21.
    Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, Begtrup K, Steiner T (2006) Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 66(8):1175–1181. doi: 10.1212/01.wnl.0000208408.98482.99 CrossRefPubMedGoogle Scholar
  22. 22.
    Wang YH, Fan JY, Luo GD, Lin T, Xie DX, Ji FY, Zhang XT (2011) Hematoma volume affects the accuracy of computed tomographic angiography ‘spot sign’ in predicting hematoma expansion after acute intracerebral hemorrhage. Eur Neurol 65(3):150–155. doi: 10.1159/000324153 CrossRefPubMedGoogle Scholar
  23. 23.
    Morotti A, Romero JM (2016) Effect of CTA tube current on spot sign detection and accuracy for prediction of intracerebral hemorrhage expansionGoogle Scholar
  24. 24.
    Tsukabe A, Watanabe Y, Tanaka H, Kunitomi Y, Nishizawa M, Arisawa A, Yoshiya K, Shimazu T, Tomiyama N (2014) Prevalence and diagnostic performance of computed tomography angiography spot sign for intracerebral hematoma expansion depend on scan timing. Neuroradiology 56(12):1039–1045. doi: 10.1007/s00234-014-1430-3 CrossRefPubMedGoogle Scholar
  25. 25.
    Dowlatshahi D, Yogendrakumar V, Aviv RI, Rodriguez-Luna D, Molina CA, Silva Y, Dzialowski I, Czlonkowska A, Boulanger JM, Lum C, Gubitz G, Padma V, Roy J, Kase CS, Bhatia R, Hill MD, Demchuk AM (2016) Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand. International Journal of Stroke : Official Journal of the International Stroke Society 11(2):191–197. doi: 10.1177/1747493015616635 CrossRefGoogle Scholar
  26. 26.
    Dowlatshahi D, Brouwers HB, Demchuk AM, Hill MD, Aviv RI, Ufholz LA, Reaume M, Wintermark M, Hemphill JC 3rd, Murai Y, Wang Y, Zhao X, Wang Y, Li N, Sorimachi T, Matsumae M, Steiner T, Rizos T, Greenberg SM, Romero JM, Rosand J, Goldstein JN, Sharma M (2016) Predicting intracerebral hemorrhage growth with the spot sign: the effect of onset-to-scan time. Stroke; a Journal of Cerebral Circulation 47(3):695–700. doi: 10.1161/strokeaha.115.012012 PubMedCentralGoogle Scholar
  27. 27.
    Kim SH, Jung HH, Whang K, Kim JY, Pyen JS, Oh JW (2014) Which emphasizing factors are most predictive of hematoma expansion in spot sign positive intracerebral hemorrhage? AJNR Am J Neuroradiol 56(2):86–90. doi: 10.3340/jkns.2014.56.2.86 Google Scholar
  28. 28.
    Barras CD, Tress BM, Christensen S, MacGregor L, Collins M, Desmond PM, Skolnick BE, Mayer SA, Broderick JP, Diringer MN, Steiner T, Davis SM (2009) Density and shape as CT predictors of intracerebral hemorrhage growth. Stroke; a Journal of Cerebral Circulation 40(4):1325–1331. doi: 10.1161/strokeaha.108.536888 CrossRefGoogle Scholar
  29. 29.
    Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, Pontes-Neto O, Ayres A, Vashkevich A, Schwab KM, Rosand J, Viswanathan A, Gurol ME, Greenberg SM, Goldstein JN (2016) Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage. JAMA Neurology 73(8):961–968. doi: 10.1001/jamaneurol.2016.1218 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2017

Authors and Affiliations

  • Zhiyuan Yu
    • 1
  • Jun Zheng
    • 1
  • Lu Ma
    • 1
  • Rui Guo
    • 1
  • Mou Li
    • 2
  • Xiaoze Wang
    • 2
  • Sen Lin
    • 1
  • Hao Li
    • 1
  • Chao You
    • 1
    Email author
  1. 1.Department of NeurosurgeryWest China Hospital, Sichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina

Personalised recommendations