The Clinical Study Of Early Hematoma Expansion On Imaging Findings And Grading Scales In Patients With Intracerebral Hemorrhage

Part one Imaging study in predicting early hematoma expansion in patients with intracerebral hemorrhageBackground: Early hematoma expansion is associated with poor outcome in patients with intracerebral hemorrhage(ICH).The blend sign(BS),the black hole sign(BHS),swirl sign(SS),margin irregular(MI)and density heterogeneous(DH)are imaging markers in ICH patients.The aim of this study was to compare the predictive value of these 5 signs for early hematoma expansion.Material/Methods: ICH patients were screened for the appearance of the 5 signs within 6 h after onset of symptoms.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of the 5 signs in predicting early hematoma expansion were assessed.The accuracy of the 5 signs in predicting early hematoma expansion was analyzed by receiver-operator analysis.Results: A total of 200 patients were enrolled in this study.The sensitivity,specificity,PPV,and NPV of BHS for predicting early hematoma expansion were 33.8%,95.3%,80.0%,and 72.0%,respectively.The sensitivity,specificity,PPV,and NPV of SS were 46.5%,71.3%,47.0%,and 71.0%,respectively.The sensitivity,specificity,PPV,and NPV of BS were 35.2%、95.4%、80.6%、72.8%.The sensitivity,specificity,PPV,and NPV of MI were 52.1%、78.0%、54.4%、74.2%.The sensitivity,specificity,PPV,and NPV of DH were 42.5%、75.2%、48.4%、70.3%.The area under the curve was 0.589、0.646、0.653、0.640、0.58 for SS、BHS、BS、MI、DH.Multivariate logistic regression showed that presence of BHS and BS are an independent predictor of early hematoma expansion.Conclusions: The presence of swirl sign、margin irregular and density heterogeneou on admission CT does not independently predict hematoma expansion in patients with ICH.The blend sign and the black hole sign can independently predict hematoma expansion in patients with ICH.Part two A clinical study of grading scales in patients with intracerebral hemorrhageBackground: The outcome of intracerebral hemorrhage(ICH)is poor and the treatment is limited.It is of great significance for clinical to predict prognosis accurately.Original ICH score,modified ICH score,ESSEN score,ICH grading scale,new modified ICH score,outcome score,simplified ICH score,Landseed ICH score,The ICH Index,ICH functional outcome score and the max-ICH score were used to predict the outcome of ICH.The aim of this study was to compare the predictive value of these grading scales for outcome.Material/Methods: Clinical and imaging data of patients with ICH within 6 h after onset of symptoms were collected.The functional outcome was assessed using the modified Rankin Scale(m RS)at 3 month.Outcome was dichotomized as favorable and poor outcome from the 3 month m RS score.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of these grading scales in predicting outcome were assessed.The accuracy of the grading scales in predicting poor functional outcome and death were analyzed by receiver-operator analysis.Results: A total of 298 patients were enrolled in this study.Poor functional outcome at 3 months was 51%,and mortality within 3 months was 18.5%.The highest area under curve(AUC)for poor functional outcome was 0.776(modified ICH score),and the lowest AUC for poor functional outcome was 0.659(simplified ICH score).The highest area under curve(AUC)for death was 0.822(ICH functional outcome score),and the lowest AUC for death was 0.764(simplified ICH score).All the negative predictive values for death were over 90%.Conclusions: These grading scales show an acceptable predictive valuble for poor outcome and death.The modified ICH score are more accurate prognostic grading scales for poor functional outcome,and the ICH functional outcome score are more accurate prognostic grading scales for death.