| Objective:Hematoma expansion is a potentially predictable predictor of poor prognosis in patients with Intracerebral hemorrhage.To analyze the risk factors of Hematoma expansion in patients with Intracerebral hemorrhage,and to actively prevent and treat Hematoma expansion,improve the prognosis of patients with Intracerebral hemorrhage and reduce mortality.The incidence of CT scan and the appearance of CTA are the imaging predictors of Hematoma expansion.The purpose of this study was to investigate the predictive value of blend sign and spot sign on Hematoma expansion in patients with Intracerebral hemorrhage,and to analyze the risk factors.Methods:A total of 186 patients with Intracerebral hemorrhage admitted to the Department of Cerebrovascular Diseases,Second Affiliated Hospital of Kunming Medical University from March 2016 to December 2018 were screened.Clinical and imaging data of the patients were collected,including gender,age,past history,admission GCS score,admission systolic blood pressure,admission diastolic blood pressure,blood glucose,blood lipids,inflammatory factors,hematoma location,size,shape,density,and the like.Immediately after admission,all patients underwent basic data collection(gender,age,past history,admission GCS score),vital signs monitoring(admission systolic blood pressure,admission diastolic blood pressure)and laboratory tests(blood routine,biochemical complete,coagulation function,acute infection)Three items,and baseline CT and CTA scans within 6 hours of onset.determine the location,size,shape and density of the hematoma(blend sign and spot signs),and review the CT to determine whether there is hematoma expansion after 24 hours of onset,according to the judgment Results Patients with Intracerebral hemorrhage who met the inclusion criteria were divided into hematoma expansion group and non-hematoma expansion group,including 56 cases of hematoma expansion group and 130 cases of non-hematoma expansion group.Self-designed clinical data statistical questionnaire,statistics of relevant factors,using SPSS20.0 statistical software to analyze the relationship between the variables and Hematoma expansion in patients with Intracerebral hemorrhage,wherein the measurement data is expressed as mean ± standard deviation(x±s),for normal Distribution test,comparison between groups using two independent sample t test for analysis;count data using a completely random design four-grid table and multi-component chi-square test(X2 test)for analysis;respectively calculated blend signs and spots signs sensitivity to hematoma expansion Degree,specificity,diagnostic efficiency,positive predictive value,negative predictive value,and using the receiver operating characteristic curve(ROC curve),calculate the area under the curve to compare the accuracy of the blend sign and the spot sign to predict hematoma expansion.The values of the variables selected and excluded were 0.05,and P<0.05 was considered statistically significant.Results:A total of 186 patients with Intracerebral hemorrhage were enrolled in the study,including 56 patients with hematoma expansion and 130 patients with non-hematoma expansion.In the CT and CTA scans within 6 hours after onset,36 patients had blend signs,and 45 patients had spot signs.Among them,20 cases and 25 cases had blend signs and spots in the enlarged group of hematoma,and blend signs in the non-hematoma expansion group.The number of spots signs was 16 and 20,respectively.The number of blend signs and spots signs in the enlarged hematoma group was significantly higher than that in the non-hematoma expansion group.The difference between the two groups was statistically significant(P<0.05).In the analysis of the characteristics of blend signs and spot signs,only 12 patients with blend signs were found,and 4 patients developed hematoma expansion(33.33%)Only 21 patients with spots signs were enrolled,and 9 patients developed hematoma expansion(42.86%).Twenty-four patients had blend signs and spot signs,and 16 patients had hematoma expansion(66.67%).There were 129 patients with no blend signs and no spot signs,and 27 patients had hematoma expansion(20.93%).At the same time,the proportion of hematoma expansion in patients with blend signs and spot signs was significantly higher than that in patients with only spot signs or blend signs or both(66.67%vs33.33%vs 42.86%vs 20.93%).The sensitivity,specificity,positive predictive value and negative predictive value of blend signs and spot signs were 35.71%vs 44.64%,87.69%vs 84.62%,55.56%vs 55.56%,73.91%vs 78.01%.The sensitivity and negative predictive value of the spot sign were found to be higher than the blend sign,while the specificity were lower than the blend sign,and the positive predictive values were roughly equal.The area under the ROC curve of the blend sign and the spot sign was 0.617 and 0.642,respectively.Among the other related factors,there was no significant difference in the gender,age and past history between the two groups(P>0.05).The GCS score,admission blood pressure,blood glucose,blood lipid,inflammatory factor,baseline hematoma volume were compared between the two groups.There were significant differences in hematoma sites,hematoma morphology,blend signs and spot signs(P<0.05).Conclusion:Admission GCS score,admission blood pressure,blood glucose,blood lipids,inflammatory factors,baseline hematoma volume,hematoma site,hematoma morphology,blend signs,and spot signs were all associated with intracerebral hemorrhage.blend signs and spot signs are significant for the prediction of hematoma expansion in patients with intracerebral hemorrhage.CT blend signs are easily recognized on conventional non-enhanced CT and have a high specificity for hematoma expansion prediction.The CTA spot sign is more sensitive to predicting hematoma expansion and is more likely to detect patients with high hematoma expansion risk.The presence of blend signs and spot signs can better identify patients with high hematoma expansion risk. |
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