title: Computed Tomographic Blend Sign Is Associated With Computed Tomographic Angiography Spot Sign and Predicts Secondary Neurological Deterioration After Intracerebral Hemorrhage.
abstract: OBJECTIVE
  Significant early hematoma growth in patients with intracerebral hemorrhage is an independent predictor of poor functional outcome. Recently, the novel blend sign (BS) has been introduced as a new imaging sign for predicting hematoma growth in noncontrast computed tomography. Another parameter predicting increasing hematoma size is the well-established spot sign (SS) visible in computed tomographic angiography. We, therefore, aimed to clarify the association between established SS and novel BS and their values predicting a secondary neurological deterioration.
  
  
  METHODS
  Retrospective study inclusion criteria were (1) spontaneous intracerebral hemorrhage confirmed on noncontrast computed tomography and (2) noncontrast computed tomography and computed tomographic angiography performed on admission within 6 hours after onset of symptoms. We defined a binary outcome (secondary neurological deterioration versus no secondary deterioration). As secondary neurological deterioration, we defined (1) early hemicraniectomy under standardized criteria or (2) secondary decrease of Glasgow Coma Scale of >3 points, both within the first 48 hours after symptom onset.
  
  
  RESULTS
  Of 182 patients with spontaneous intracerebral hemorrhage, 37 (20.3%) presented with BS and 39 (21.4%) with SS. Of the 81 patients with secondary deterioration, 31 (38.3%) had BS and SS on admission. Multivariable logistic regression analysis identified hematoma volume (odds ratio, 1.07 per mL; P≤0.001), intraventricular hemorrhage (odds ratio, 3.08; P=0.008), and the presence of BS (odds ratio, 11.47; P≤0.001) as independent predictors of neurological deterioration.
  
  
  CONCLUSIONS
  The BS, which is obtainable in noncontrast computed tomography, shows a high correlation with the computed tomographic angiography SS and is a reliable predictor of secondary neurological deterioration after spontaneous intracerebral hemorrhage.
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.). Peter.Sporns@ukmuenster.de.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Sporns
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Michael
authors.initials: M
authors.lastname: Schwake
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Rene
authors.initials: R
authors.lastname: Schmidt
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: André
authors.initials: A
authors.lastname: Kemmling
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schwindt
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Christian
authors.initials: C
authors.lastname: Cnyrim
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Tarek
authors.initials: T
authors.lastname: Zoubi
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
authors.affiliation: From the Department of Clinical Radiology (P.B.S., W.S., C.C., T.Z., W.H., T.N., U.H.), Department of Neurosurgery (M.S.), and Department of Neurology (J.M.), University Hospital of Muenster, Germany; Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); and Institute of Neuroradiology, University Hospital of Luebeck, Germany (A.K.).
authors.forename: Uta
authors.initials: U
authors.lastname: Hanning
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000072226:Computed Tomography Angiography / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: angiography; diabetes mellitus; hematoma; hypertension; infarction