title: Black Hole Sign: Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage.
abstract: Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage.
  
  
  
  Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth.
  
  
  
  A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of back hole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model.
  
  
  
  The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage.
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); 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 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Gang
authors.initials: G
authors.lastname: Zhang
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Xin
authors.initials: X
authors.lastname: Xiong
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Xing-Chen
authors.initials: XC
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Wen-Song
authors.initials: WS
authors.lastname: Yang
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.).
authors.forename: Ke-Wei
authors.initials: KW
authors.lastname: Li
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.). xiepeng@cqmu.edu.cn 1259446388@qq.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wei
authors.affiliation: From the Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (Q.L., G.Z., X.-C.W., W.-S.Y., K.-W.L., P.X.); Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China (X.X.); and Department of Medical Technology, Chongqing Medical and Pharmaceutical College, Chongqing, China (X.W.). xiepeng@cqmu.edu.cn 1259446388@qq.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D014057:Tomography, X-Ray Computed
keywords: cerebral hemorrhage; hematoma; logistic models; sensitivity and specificity; tomography, x-ray computed