The Accuracy Of The Blend Sign For Predicting The Hematoma Enlargement Of The Spontaneous Intracerebral Hemorrhage

Objective Theblend sign is a simple and intuitive imaging Sign that can be used to predict the expansion of intracerebral hematoma in non-enhanced computed tomography(ct).Some studies reports that the blend sign is highly specific in predicting the hematoma enlargement.This study aims to explore the accuracy of the blend sign for predicting the the hematoma enlargement of the spontaneous intracerebral hemorrhage.Methods From January 2017 to October 2018,316 patients(178 males and 138females)with spontaneous intracerebral hemorrhage admitted to the department of neurology,Baotou Central Hospital,Inner Mongolia were recruited to this study.All the patients received baseline CT scan of the head within 6 hours after the onset of symptoms and were repeated head CT scan within 24 hours after the onset of symptoms.The criterion for the enlargement of the intracerebral hematoma was defined as 33% increase in the volume of intracerebral hematoma or an absolute increase of12.5ml in the volume of hematoma.The definition of the blend sign characters are: the enhanced computer tomography of the head on plain radiographs,brain hematoma by two kinds of relative consists of a mix of high and low density,and with clear boundaries between high and low density hematoma,easy to clear recognition to the naked eye,there are at least 18 HU,differences between the density and relatively low density hematoma was wrapped by high density hematoma area.Cerebral hemorrhage or hematoma after brain trauma,surgical removal of hematoma enlargement,aneurysm rupture,moyamoya disease,amyloidosis,tumor,vasculitis and other secondary cerebral hemorrhage stroke were excluded.The sensitivity,specificity,positive and negative predictive values of the blend signs in predicting hematoma enlargement were calculated.The Accuracy of the Blend Sign in predicting the the hematoma enlargement was analyzed by receiver-operator analysis.Results A total of 316 patients were included in this study,(178 males and 138females).Bleeding with basal ganglia region was 169 case(53.6%),cerebral lobe was38 cases(12%),thalamus was 77 cases(24.5%),brain stem was 12 cases(3.9%),cerebellum was 19 cases(6%)。 Thirty-nine patients(12.34%)with intracerebral hemorrhage had the blend signs in the baseline non-enhanced head CT scan,while 29patients(74.36)with the spontaneous intracerebral hemorrhage with the blend sign developed enlarged hematoma.The sensitivity,specificity,positive and negative predictive values of mixed signs in predicting hematoma growth were 40.3 %,95.9%,74.4% and 84.5% respectively,and the area under the curve was 0.681.Conclusion The blend sign is a good imaging sign for predicting enlargement of intracerebral hematoma,in particular,it is highly specific for predicting the enlargement of intracerebral hematoma.