| Objective By comparing the admission time of patients with spontaneous intracerebral hemorrhage(SICH)and reexamining the CT plain film of their heads,this paper discusses whether there is independent correlation between Swirl Sign(SS)and early Hematoma Enlargement(HE).Methods The general data,clinical data,imaging data and 90-day prognosis data of 116 SICH patients who visited the neurosurgery department of Ordos Central Hospital and Dongsheng District People’s Hospital from June 1,2019 to July 1,2020 were collected continuously.According to the inclusion and exclusion criteria,the patients were divided into inclusion group and exclusion group,and the general data of the two groups were compared respectively.According to whether swirl sign appeared in CT hematoma on admission,the patients were divided into swirl sign positive group and swirl sign negative group,and the general data,clinical data and imaging data of the two groups were compared respectively.Then 3D Slicer software was used to calculate the volume of hematoma on skull CT when the patient was admitted to hospital and reexamined within 24 hours of onset.CT2 was subtracted from CT1 to calculate the early hematoma enlargement.according to whether the hematoma enlarged by more than 33% or increased by more than 12.5ml compared with the skull CT hematoma at admission,the included patients were divided into hematoma enlargement group and hematoma stabilization/reduction group,and the general data,clinical data and imaging data of the two groups were compared respectively.Then,according to the prognosis collected from the 90-day follow-up,the patients were divided into good prognosis group(≤2 points)and poor prognosis group(≥3 points)by using the improved Rankin score(MRS),and the general data,clinical data and imaging data of the two groups were compared respectively.Advanced univariate analysis,meaningful variables of univariate analysis were included in multivariate Logistic regression analysis.P<0.05 was statistically significant,and whether swirl sign is an independent risk factor for HE and poor prognosis was analyzed.Results(1)Among 116 patients,88 patients were included,and there was no significant difference in general data between 88(75.9%)of the included group and28(24.1%)of the excluded group(P<0.05).(2)Among the 88 cases,31(35.2%)had swirl sign,and compared with 57(64.8%)without swirl sign,it was found that the initial hematoma volume,cerebral hernia rate,ventricular hemorrhage rate and HE rate in swirl sign positive group were higher than those in swirl sign negative group,all P<0.05,with statistical significance.(3)Comparing 27 cases(30.7%)with 61cases(69.3%)with stable/reduced hematoma,it was found that the incidence of cerebral hernia and swirl sign in the enlarged group was higher than that in the stable/reduced group(P<0.05).(4)comparing 55(62.5%)patients with good prognosis with 33(37.5%)patients with poor prognosis,it was found that the age,previous diabetes history,cerebral hemorrhage history,hematoma initial volume level,cerebral hernia incidence,ventricular hemorrhage incidence,swirl sign incidence and hematoma obvious increase incidence of good prognosis group were all lower than those of poor prognosis group(P<0.05)(5)Meaningful single factor and HE Using multivariate Logistic regression analysis,it is found that swirl sign is an independent risk factor for HE.(6)Meaningful Univariate and 90-day Prognosis Using multivariate Logistic regression analysis,it was found that swirl sign,initial hematoma volume and HE were independent risk factors for poor prognosis.Conclusion(1)Swirl sign has independent correlation with HE of patients.(2)We can use swirl sign as an imaging index to predict HE in SICH patients.(3)Swirl sign,initial hematoma volume and HE are all independently correlated with the90-day prognosis.(4)We can use swirl sign,initial volume of hematoma and HE as related indicators to predict the 90-day poor prognosis of SICH patients.(5)For patients with positive swirl sign on admission,we suggest CTA examination to rule out aneurysm.(6)We suggest that the application of vortex sign should be extended to grass-roots hospitals,so as to facilitate the diagnosis and treatment of grass-roots hospitals and improve the quality of life of patients. |
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