Predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage

Abstract

Objective To explore the predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage (sICH). Methods A total of 84 patients with sICH were admitted to Department of Neurosurgery, Wenjiang District People′s Hospital of Chengdu from January 2015 to December 2017 and consecutively enrolled into this study. The time from onset to the first CT examination was ≤6 h, and the second CT examination time was ≤24 h. According to the results of those 2 examinations, the patients were divided into the early hematoma enlargement group (35 cases) and the hematoma non-enlargement group (49 cases). The effects of CT island signs and blend signs on early hematoma enlargement and their diagnostic efficacy for early hematoma enlargement were analyzed. Results Non-contrast CT scan showed that 60.0% (21/35) in the early hematoma enlargement group had island sign, and 71.4% (25/35) had blend sign. Compared with 14.3% (7/49) and 24.5% (12/49) in non-enlargement group, those differences were statistically significant (both P<0.01). Multivariate logistic regression analysis revealed that both island sign (OR=12.720, 95% CI: 3.501-46.218, P<0.01) and blend sign (OR=10.793, 95% CI: 3.172-36.727, P=0.01) were independent predictors of early hematoma enlargement. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of island sign for early hematoma enlargement were 60.0%, 85.7%, 75.0%, 75.0% and 45.7% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of blend sign for early hematoma enlargement were 71.4%, 75.5%, 67.6%, 78.7% and 46.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of island sign combined with blend sign for early hematoma enlargement were 91.4%, 63.3%, 64.0%, 91.2% and 54.7% respectively. Conclusions Island sign and blend sign are independent predictors of early enlargement of hematoma. The diagnostic performance with the combination of island sign and blend sign seems higher than the that of either single indicator. Key words: Spontaneous intracerebral hemorrhage; X-ray computed tomography; Hematoma enlargement; Island sign; Blend sign