Abstract
Background: The aim of this study was to assess the inter- and intrarater reliability of noncontrast CT (NCCT) markers [Black Hole Sign (BH), Blend Sign (BS), Island Sign (IS), and Hypodensities (HD)] and Spot Sign (SS) on CTA in patients with spontaneous intracerebral hemorrhage (ICH). Methods: Patients with spontaneous ICH at three German tertiary stroke centers were retrospectively included. Each CT scan was rated for four NCCT markers and SS on CTA by two radiology residents. Raters were blind to all demographic and outcome data. Inter- and intrarater agreement was determined by Cohen’s kappa (κ) coefficient and percentage of agreement. Results: Interrater agreement was excellent in 473 included patients, ranging from 96% to 99%. Interrater κ ranged from 0.85 (95% CI [0.78–0.91]) to 0.97 (95% CI [0.94–0.99]) for NCCT markers and 0.93 (95% CI [0.88–0.98]) for SS, all p-values < 0.001. Intrarrater agreement ranged from 96% to 100%, with κ ranging from 0.85 (95% CI [0.78–0.91]) to 1.00 (95% CI [0.10–0.85]) for NCCT markers and 0.96 (95% CI [0.92–1.00]) for SS, all p-values < 0.001. Conclusions: NCCT imaging findings and SS on CTA have good-to-excellent inter- and intrarater reliabilities, with the highest agreement for BH and SS.
Highlights
Intracerebral hemorrhage (ICH) is the most severe form of stroke with a one month morbidity and mortality rates approaching 50% and death or severe disability exceeding 75% [1,2,3,4]
We retrospectively studied the databases of three German tertiary stroke centers for patients with spontaneous ICH aged >18 years between January 2016 and December 2018. (University Hospital of Muenster, University Hospital Hamburg-Eppendorf and Charité University Hospital Berlin)
Hematoma expansion is a therapeutic target of clinical interventions and a potentially modifiable predictor of clinical outcome [8,27,28]
Summary
Intracerebral hemorrhage (ICH) is the most severe form of stroke with a one month morbidity and mortality rates approaching 50% and death or severe disability exceeding 75% [1,2,3,4]. Early secondary hematoma expansion due to active extravasation and rebleeding has been reported in 38% of patients after initial imaging on computed tomography (CT) and reported as an independent prognostic factor for poor functional outcome [7,8]. Several imaging markers on non-contrast computed tomography (NCCT) have been described to be predictive of hematoma expansion and poor functional outcome [6] These imaging characteristics include the blend sign (BS) [6,11], the black hole sign (BHS) [6,12,13], the island sign (IS) [6,14], and the more general appearance of hypodensities (HD) [6,15]. The aim of this study was to assess the inter- and intrarater reliability of noncontrast CT (NCCT) markers [Black Hole Sign (BH), Blend Sign (BS), Island Sign (IS), and Hypodensities (HD)] and Spot Sign (SS) on CTA in patients with spontaneous intracerebral hemorrhage (ICH). Conclusions: NCCT imaging findings and SS on CTA have good-to-excellent inter- and intrarater reliabilities, with the highest agreement for BH and SS
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