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Journal of Neurosurgical Sciences 2021 Apr 16

DOI: 10.23736/S0390-5616.21.05257-7


language: English

Feasibility of a combined swirl and blending sign on noncontrast computed tomography for predicting early hematoma expansion after spontaneous intracerebral hemorrhage

Jang H. KIM 1, Jong-Il CHOI 2

1 Trauma Center, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea; 2 Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea


BACKGROUND: For predicting the hematoma expansion of spontaneous intracerebral hemorrhage, spot and swirl signs have been investigated. However, the clinical effectiveness of these signs remains debatable; these signs do not consider the peripheral hypodense lesions, which may imply a greater chance of ongoing bleedings. We proposed a new “combined swirl and blending sign,” and evaluated its clinical usefulness in predicting hematoma expansion in non-contrast computed tomography settings.
MATERIAL AND METHODS: A total of 201 patients who were diagnosed with spontaneous intracerebral hemorrhage were enrolled. Their clinical and radiologic data were retrospectively reviewed. Patients were classified into hematoma expansion (n=51) and non-expansion groups (n=150), and multivariable logistic regression analyses were performed to identify the factors associated with hematoma expansion.
RESULTS: In the hematoma expansion group, an average of 20 mL of volume increase was noted. In multivariate analyses, several factors, including systolic blood pressure (p=0.026), initial hematoma volume (0.002), spot sign (0.019) and combined swirl and blending sign (<0.001), were identified as reliable predictors of hematoma expansion. A swirl (p=0.396) or blending sign (p=0.124) alone was not identified as a significant predictor of hematoma growth. The sensitivity, specificity, and positive and negative predictive values of the combined swirl and blending sign were 31%, 97%, 80%, and 81%, respectively.
CONCLUSIONS: A newly defined “combined swirl and blending sign” on non-contrast computed tomography was positively associated with an increased risk of hematoma expansion of spontaneous intracerebral hemorrhage and could be regarded as a reliable predictor in non-contrast computed tomography settings.

KEY WORDS: Blending sign; Hematoma expansion; Spontaneous intracerebral hemorrhage; Swirl sign

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