title: Blend Sign on Computed Tomography: Novel and Reliable Predictor for Early Hematoma Growth in Patients With Intracerebral Hemorrhage.
abstract: OBJECTIVE
  Early hematoma growth is not uncommon in patients with intracerebral hemorrhage and is an independent predictor of poor functional outcome. The purpose of our study was to report and validate the use of our newly identified computed tomographic (CT) blend sign in predicting early hematoma growth.
  
  
  METHODS
  Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Significant hematoma growth was defined as an increase in hematoma volume of >33% or an absolute increase of hematoma volume of >12.5 mL. The blend sign on admission nonenhanced CT was defined as blending of hypoattenuating area and hyperattenuating region with a well-defined margin. Univariate and multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on nonenhanced admission CT and early hematoma growth.
  
  
  RESULTS
  A total of 172 patients were included in our study. Blend sign was observed in 29 of 172 (16.9%) patients with intracerebral hemorrhage on baseline nonenhanced CT scan. Of the 61 patients with hematoma growth, 24 (39.3%) had blend sign on admission CT scan. Interobserver agreement for identifying blend sign was excellent between the 2 readers (κ=0.957). The multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and presence of blend sign on baseline CT scan to be independent predictors of early hematoma growth. The sensitivity, specificity, positive and negative predictive values of blend sign for predicting hematoma growth were 39.3%, 95.5%, 82.7%, and 74.1%, respectively.
  
  
  CONCLUSIONS
  The CT blend sign could be easily identified on regular nonenhanced CT and is highly specific for predicting hematoma growth.
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.). peng_xie@yahoo.com drgangzhang@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Yuan-Jun
authors.initials: YJ
authors.lastname: Huang
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Mei-Xue
authors.initials: MX
authors.lastname: Dong
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Fa-Jin
authors.initials: FJ
authors.lastname: Lv
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Xiao
authors.initials: X
authors.lastname: Wei
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Xin-Yue
authors.initials: XY
authors.lastname: Qin
authors.affiliation: From the Departments of Neurology (Q.L., G.Z., Y.J.H, M.X.D., J.J.C., X.Y.Q., P.X.) and Radiology (F.J.L., L.J.Z.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.). peng_xie@yahoo.com drgangzhang@126.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006407:Hematoma, Epidural, Cranial / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: cerebral hemorrhage; computed tomography; diagnostic imaging; hematoma; stroke