| Objective: Hematoma expansion(HE)is easily found in patients with spontaneous intracerebral hemorrhage(s ICH),which is associated with neurological deterioration and high mortality.The blend sign and spot sign are distinguished from the CT and CTA of brain in patients with s ICH,and both are independent neuroimaging predictors of HE.The purpose of this study is to explore the value of CT blend sign and CTA spot sign in the prediction of HE with s ICH patients.Methods: We retrospectively analyzed clinical and neuroimaging data from 136 patients with s ICH,who were treated at Qinghai Provincial People's Hospital between September 2015 and August 2017.According to the CT and CTA of brain performed upon admission(within 6h of the onset of symptoms)to identify blend sign and spot sign.HE was determined based on CT during a follow-up 24 h later.Determine the incidence of blend sign and spot sign in HE group and non-HE group,respectively.The sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)with which blend sign and spot sign predicted HE were calculated and compared.Receiver operating characteristic(ROC)curve analysis was performed in order to compare the accuracy of the two signs in predicting HE.Results: Of the 136 patients with s ICH,a total of 41 patients were found have HE.Age,sex,nationality,history of hypertension,history of diabetes,platelet(PLT)and admission blood pressure(both systolic blood pressure and diastolic blood pressure)were all have no relationships with HE after s ICH(P > 0.05).28(20.59%)patients had blend sign on CT of the brain upon admission,33(24.26%)patients had spot sign on CTA of the brain.Among 41(30.15%)HE patients,the patients with blend sign and spot sign were 15 cases and 18 cases respectively.Both blend sign and spot sign were found in 19 patients,and 12(63.16%)had HE.14 patients with only spot sign but no blend sign,we found 6(42.86%)had HE.Of 9 patients with only blend sign,3(33.3%)had HE.Patients both have blend sign and spot sign,the incidence of HE increased significantly(63.16%).The incidence of HE was higher in patients with spot sign only than those only found blend sign patients(42.86% to 33.33%).The sensitivity of blend sign in predicting HE was 36.59%,specificity was 86.32%,PPV was 53.57%,and NPV was 5.93%,respectively.The sensitivity of spot sign in predicting HE was 43.90%,specificity was 84.21%,PPV was 54.55%,and NPV was 77.67%,respectively.The area we calculated under the ROC curve in predicting HE was 0.615 for blend sign and 0.641 for spot sign(p=0.736).Conclusion: First CT time,the initial volume of hematoma,intraventricular hemorrhage,CT blend sign and CTA spot sign are all the effective predictors of HE in patients with s ICH.The CT blend sign and CTA spot sign are both good predictors of HE,but the prediction accuracy of spot sign is relatively higher.The risk of HE is higher in s ICH patients with both blend sign and spot sign.In the medical institutions that are not available to perform CTA examination in the early stage of s ICH,the blend sign acquired based on NCCT,it's significance in predicting HE and guiding clinical treatment is particularly important. |
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