BACKGROUND AND PURPOSE: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.METHODS: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.RESULTS: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.CONCLUSIONS: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.

Intracerebral hemorrhage (ICH) constitutes 10% to 30% of first-ever strokes and is associated with high morbidity and mortality. The reported 30-day mortality of ICH ranges from 30% to 50% and nearly half of the patients died within 2 days after the onset of symptoms. The initial hematoma volume, level of consciousness, and intraventricular extension of bleeding are well-established predictors of functional outcome in patients with ICH. Early hematoma expansion is reported in 19% to 38% of patients with ICH and is associated with poor functional outcome. Identification of useful imaging predictor for hematoma expansion is crucial for therapeutic intervention. The computed tomography angiography (CTA) spot sign is a well-established imaging marker that independently predicts hematoma expansion in patients with ICH. A recent large-scale multicenter observational study suggests that the sensitivity and specificity of CTA spot sign in predicting hematoma expansion were 51% and 85%, respectively. However, early CTA examination requires contrast administration and was contraindicated in patients with several renal function impairment. In addition, CTA spot sign requires immediate admission of CTA examination within the first several hours after onset of symptoms, which was not applicable in many institutions. Therefore, scrutinizing nonenhanced CT scan for possible imaging predictors of hematoma expansion is urgently demanded for patients with ICH. We have identified a new CT-based sign called the black hole sign that may be used as a novel imaging Background and Purpose—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. Methods—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. Results—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. Conclusions—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. (Stroke. 2016;47:1777-1781. DOI: 10.1161/STROKEAHA.116.013186.)

Background and Purpose— 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. Methods— 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. Results— 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. Conclusions— 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.

BackgroundCerebral perfusion pressure (CPP) can adversely impact cerebrovascular hemodynamics but cannot be practically measured in most clinical settings. Here, we aimed to establish a representative mathematical model for CPP in geriatric patients with suspected cerebrovascular disease.MethodsA total of 100 patients (54 males and 46 females between 60-80 years of age) with suspected cerebrovascular disease and no obvious cerebrovascular stenosis were selected for invasive CPP monitoring via catheterization of the middle segment of the common carotid arteries and openings of the vertebral arteries bilaterally. Curves were function-fitted using MATLAB 7.0, and data was statistically processed by SPSS 20.0.ResultsMATLAB 7.0 constructed eighth-order Fourier functions that fit all recorded CPP curves. Since the coefficients of the 100 functions were significantly different, all functions were standardized to derive one representative function. By manipulating the heart rate and maximum/minimum CPP of the representative function, estimated CPP curves can be constructed for patients with differing heart rates, intracranial pressures (ICPs) and blood pressures.ConclusionsCPP can be well-modeled through an eighth-order Fourier function that can be constructed from a patient's brachial artery blood pressure (BABP), ICP and heart rate. This function is representative of geriatric patients with cerebrovascular disease and can be used in the future study of cerebral hemodynamics.

The circle of Willis is a major collateral circulation that has an important role in ischemic events. The purpose of our study was to investigate the collateral circulation in a Chinese population with 64-section multidetector CT angiography (CTA). A total of 170 patients who underwent 64-section CT angiography at The First Affiliated Hospital of Chongqing Medical University were included in our study. The morphological variations in the anterior and posterior circle of Willis were assessed in each patient. A total of 160 patients were included in the final analysis, of whom 126 (79%) demonstrated a complete anterior circle of Willis, and 50 (31%) had a complete posterior circle of Willis. A complete circle of Willis was seen in 43 of 160 participants (27%). A fetal-type posterior circle of Willis was seen in 15 (9.4%) patients. This is the first report of a CTA study of collateral circulation in a Chinese population. A higher prevalence of compromised posterior collaterals was observed in this Chinese population compared to Western and Japanese populations.

PURPOSE To investigate the diagnostic performance of 64-section computed tomographic (CT) angiography in the detection of intracranial aneurysms. MATERIALS AND METHODS This study was approved by the institutional review board; written informed consent was obtained. One hundred eight consecutive patients suspected of having intracranial aneurysms were recruited. All patients underwent both 64-detector CT angiography and digital subtraction angiography (DSA) for the detection of intracranial aneurysms. CT angiograms were reviewed by two independent blinded readers. Sensitivity, specificity, and positive and negative predictive values for aneurysm detection with CT angiography were calculated by using DSA and surgical findings as the reference standard. RESULTS One hundred seven aneurysms were seen in 96 patients. Of those, DSA helped detect 106. On a per-aneurysm basis, the sensitivity, specificity, and positive and negative predictive values for CT angiography were 99%, 100%, and 100% and 92.3%, respectively. For aneurysms smaller than 3 mm, sensitivity was 93.7% for reader 1 and 96.8% for reader 2. However, the sensitivity and specificity were both 100% for aneurysms larger than 3 mm. Therapeutic decisions could be made on the basis of information provided by CT angiography. CONCLUSION Sixty-four-detector CT angiography is an accurate imaging method for the detection of aneurysms. It may be used as the initial imaging technique in the diagnostic work-up of patients suspected of having intracranial aneurysms.

The purpose of our study was to compare the diagnostic performance of subtraction computed tomography angiography (CTA) with conventional nonsubtracted CTA and digital subtraction angiography (DSA) for the detection of intracranial aneurysms. A total of 76 patients underwent both subtraction CTA and conventional CTA for the detection and therapy planning of suspected intracranial aneurysms. Subtraction and conventional CTA images were independently assessed by two readers in a blinded manner. The possibility of endovascular treatment or surgical clipping was also assessed based on information provided by CT angiograms alone. In 64 patients, 75 aneurysms were present on DSA. On a per-aneurysm basis, the sensitivity of subtraction CTA was 98.6% for reader 1, and 100% for reader 2. However, sensitivity of conventional CTA was 94.6% for reader 1, and 93.3% for reader 2. Therapeutic decisions could be made regarding 63 patients based on information provided by subtraction CTA images. However, conventional CTA provided sufficient information to make this decision for 55 patients. Conventional CTA has limited sensitivity in detecting very small aneurysms as well as aneurysms adjacent to bone. Subtraction CTA performed on a 64-row multidetector CT is an accurate and promising diagnostic tool that seems to be equivalent to 2D DSA for the detection and pretreatment planning of intracranial aneurysms.