Correlation Of Blend Sign With Risk Factors Of Intra-cerebral Hemorrhage

Objective:Blend sign is defined as blending of a hypo-attenuating area and a hyperattenuating region with a well-defined margin on Computed Tomography(CT).It is a novel and reliable predictor of early hematoma growth while early hematoma growth is a promising predictor of poor functional outcome[1].Intra-cerebral hemorrhage is one of the most disabling subtypes of stroke.New modalities of investigation for medical and surgical interventions have to be studied and implemented upon to prevent high rate of morbidity and mortality.The correlation of blend sign with the risk factors of Intracerebral hemorrhage(ICH)is investigated in this study to evaluate the possibility of poor functional outcome of ICH.The objectives of this study are: 1.To evaluate the correlation of blend sign with age,gender,hypertension including systolic and diastolic blood pressure,diabetes,Hemoglobin A1c(Hba1c),fasting blood glucose,High-density lipoprotein(HDL),low-density lipoprotein(LDL),total cholesterol,homocysteine,triglycerides,time from onset of hemorrhage,location,ICH volume,lacunar infarction,leukariosis and enlarged perivascular spaces(EPVS)or Virchow-robin spaces.2.To compare the difference between patient groups with and without blend sign in terms of age,gender,hypertension including systolic and diastolic blood pressure,diabetes,Hba1 c,fasting blood glucose(FBG),High-density lipoprotein(HDL),lowdensity lipoprotein(LDL),total cholesterol,homocysteine,triglycerides,time from onset of hemorrhage,location,ICH volume,lacunar infarction,leukariosis and enlarged perivascular spaces(EPVS).Materials and Methods:A retrospective study was carried out at the First affiliated hospital of Dalian Medical University.A Non-contrast CT study of ICH cases dated from September 2015 to November 2016 was performed.A total of 100 ICH cases were collected.ICH volumes were first measured using ADW 4.4 workstation.Presence or absence of blend sign was evaluated in these cases.Then grading of EPVS and leukariosis and presence and absence of lacunar infarction was noted from these images.The locations of ICH were marked and recorded.Clinical data such as age,time from onset of hemorrhage,history of hypertension,diabetes,LDL,HDL,total cholesterol,triglycerides,Hb A1 c,homocysteine and systolic and diastolic blood pressure values were reported from the patient files.Out of these 100 cases,14 cases were excluded as history of hypertension and diabetes and values of systolic and diastolic blood pressure,hb A1 c,LDL,HDL,total cholesterol,triglycerides and homocysteine were unavailable.SPSS 20.0 was used to perform the statistical analysis.A comparative and correlative study of blend sign and all data such as age,gender,hypertension,systolic blood pressure,diastolic blood pressure,diabetes,hb A1 c,FBG,LDL,HDL,totalcholesterol,triglycerides,homocysteine,time from onset of hemorrhage,ICH volume,location,EPVS,leukariosis and lacunar infarction were carried out using crosstabs,chisquare tests and Kendall’s correlation(categorical data),Mann-Whitney U test and Spearman’s correlation(non-parametric numerical data),independent sample t-test and Pearson’s correlation(numerical parametric distribution).A logistic regression test was carried out for all the data to derive their significant contribution to prediction.Results: 1.The retrospective study of 86 cases with ICH revealed 33 cases with positive blend sign(32.7%)and 53 cases with negative blend sign(52.5%).2.The mean ± S-D of ICH volume in patients with Positive blend sign was 2190.09±1318.49 ml and that of cases with negative blend sign was 1605.30±1262.58 ml.3.A comparative study of blend sign with categorical data such as gender,hypertension,diabetes,EPVS,leukariosis,lacunar infarction and location using cross-tabs and chisquare tests revealed the following results: · Significant difference was seen in blend sign positive and negative groups with regards to hypertension(P=0.024),EPVS(P= 0.049),Leukariosis(P=0.014)and lacunar infarction.(P=0.027)· Comparison between groups with and without blend sign showed no significant difference in terms of diabetes(P=0.946)and location(P=0.129).4.A comparative study of blend sign with numerical data such as age,systolic blood pressure,diastolic blood pressure,hb A1 c,FBG,LDL,HDL,total cholesterol,triglycerides,homocysteine,time from onset of hemorrhage and ICH volume using independent t-test for parametric and Mann-Whitney U test for non-parametric revealed the following results:· Significant difference was seen in blend sign positive and negative groups with regards to age(P=0.013),systolic blood pressure(P=0.000),diastolic blood pressure(P =0.000),homocysteine(P=0.042)and ICH volume(P=0.012).· Comparison between groups with and without blend sign showed no significant difference in terms of hb A1c(P= 0.416),FBG(P=0.855),LDL(P=0.590),HDL(P=0.340),total cholesterol(P=0.122),triglycerides(P=0.378)and time from onset of hemorrhage(P=0.421)5.Correlation analysis of blend sign and age,gender,hypertension including systolic and diastolic blood pressure,diabetes,Hba1 c,fasting blood glucose(FBG),High-density lipoprotein(HDL),low-density lipoprotein(LDL),total cholesterol,homocysteine,triglycerides,time from onset of hemorrhage,location,ICH volume,lacunar infarction,leukariosis and end-perivascular spaces(EPVS)using pearson correlation for parametric and spearman correlation for non-parametric and kendall’s correlation for categorical data were as follows: · Significant correlation was observed between blend sign and age(P=0.013),hypertension(P=0.004),systolic blood pressure(P=0.000),diastolic blood pressure(P=0.000),homocysteine(P=0.041),ICH volume(P=0.011),lacunar infarction(P =0.014),leukariosis(P=0.010)and EPVS(P=0.044).· No significant correlation was observed between blend sign and gender 9(P=0.291),diabetes(P=0.947),hba1c(P=0.427),fasting blood glucose(P=0.856),HDL(P=0.345),LDL(P=0.590),total cholesterol(P=0.123),triglycerides(P=0.383),time from onset of hemorrhage(P=0.424)and location(P=0.311).6.Logistic regression analysis of age,gender,hypertension including systolic and diastolic blood pressure,diabetes,Hba1 c,fasting blood glucose(FBG),High-densitylipoprotein(HDL),low-density lipoprotein(LDL),total cholesterol,homocysteine,triglycerides,time from onset of hemorrhage,location,ICH volume,lacunar infarction,leukariosis and end-perivascular spaces(EPVS)revealed the following results: · Age(P=0.017),hypertension(P=0.009),systolic blood pressure(P=0.000),diastolic blood pressure(P=0.001),lacunar infarction(P=0.019)and leukariosis(P=0.030)contribute significantly to prediction.· Gender(P=0.292),diabetes(P=0.946),hb A1c(P=0.652),FBG(P=0.835),HDL(P=0.149),LDL(P=0.583),total cholesterol(P=0.095),homocysteine(P=0.180),triglycerides(P=0.428),time from onset of hemorrhage(P=0.349),Location(P=0.946),ICH volume(P=0.052)and EPVS(P=0.206)do not contribute significantly to prediction.Conclusion:The blend sign which is a novel predictor of early hematoma growth that has poor functional outcome is correlated to age,hypertension,systolic blood pressure,diastolic blood pressure,homocysteine,ICH volume,EPVS,lacunar infarction and leukariosis.The best treatment approach is in identifying the high-risk individuals within the population for planned interventions.Thus,for prevention of fatal results in ICH,the imaging findings of blend sign particularly in aged patients with risk factors such as hypertension,increased homocysteine levels,EPVS,lacunar infarction and leukariosis will help in taking immediate management methods.