TY - JOUR
T1 - Validation of the Black-&-White sign to predict intracerebral hematoma expansion in the multi-center PREDICT study cohort
AU - Pensato, Umberto
AU - Tanaka, Koji
AU - Ospel, Johanna M.
AU - Aviv, Richard I.
AU - Rodriguez-Luna, David
AU - Hill, Micheal D.
AU - Molina, Carlos A.
AU - Silva Blas, Yolanda
AU - Boulanger, Jean Martin
AU - Gord, Gubitz
AU - Bhatia, Rohit
AU - Padma, Vasantha
AU - Roy, Jayanta
AU - Dzialowski, Imanuel
AU - Kase, Carlos S.
AU - Kobayashi, Adam
AU - Dowlatshahi, Dar
AU - Demchuk, Andrew M.
N1 - Publisher Copyright:
© 2025 World Stroke Organization.
PY - 2025
Y1 - 2025
N2 - Background: Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast computed tomography (NCCT) hypodensity and computed tomography angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for HE in a single-center cohort. In this analysis, we aimed to validate the predictive accuracy of the B&W sign for HE in a multicenter cohort. Methods: Acute ICH patients from the multicenter, observational PREDICT study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT) were included. Outcomes included HE (⩾6 mL or ⩾33%) and severe HE (⩾12.5 mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors. Results: Three hundred four patients were included, with 106 (34.9%) showing HE. The spot sign was present in 76 (25%) patients, the hypodensity sign in 119 (39.1%), and the B&W sign in 29 (9.5%). In the stratum with positive spot signs, patients with B&W signs experienced more frequent HE (79.3% vs 46.8%, p = 0.008), hematoma absolute growth (19.1 mL (interquartile range (IQR) = 6.4–40) vs 3.2 mL (IQR= 0–23.3), p = 0.018), and hematoma relative growth (92% (IQR = 16–151%) vs 24% (IQR= 0–69%), p = 0.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR) = 7.83 (95% confidence interval (CI) = 2.93–20.91)) and severe HE (adjusted OR = 5.67 (95% CI = 2.41–13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR = 61.7–90.1) for HE. Inter-rater agreement was moderate (k = 0.54). Conclusion: The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.
AB - Background: Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast computed tomography (NCCT) hypodensity and computed tomography angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for HE in a single-center cohort. In this analysis, we aimed to validate the predictive accuracy of the B&W sign for HE in a multicenter cohort. Methods: Acute ICH patients from the multicenter, observational PREDICT study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT) were included. Outcomes included HE (⩾6 mL or ⩾33%) and severe HE (⩾12.5 mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors. Results: Three hundred four patients were included, with 106 (34.9%) showing HE. The spot sign was present in 76 (25%) patients, the hypodensity sign in 119 (39.1%), and the B&W sign in 29 (9.5%). In the stratum with positive spot signs, patients with B&W signs experienced more frequent HE (79.3% vs 46.8%, p = 0.008), hematoma absolute growth (19.1 mL (interquartile range (IQR) = 6.4–40) vs 3.2 mL (IQR= 0–23.3), p = 0.018), and hematoma relative growth (92% (IQR = 16–151%) vs 24% (IQR= 0–69%), p = 0.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR) = 7.83 (95% confidence interval (CI) = 2.93–20.91)) and severe HE (adjusted OR = 5.67 (95% CI = 2.41–13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR = 61.7–90.1) for HE. Inter-rater agreement was moderate (k = 0.54). Conclusion: The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.
KW - active bleeding
KW - Hemorrhagic stroke
KW - hemostatic therapy
KW - intracranial hemorrhage
KW - radiological markers
KW - spot sign
KW - “black and white”
UR - http://www.scopus.com/inward/record.url?scp=85215063618&partnerID=8YFLogxK
U2 - 10.1177/17474930241307466
DO - 10.1177/17474930241307466
M3 - Article
C2 - 39623688
AN - SCOPUS:85215063618
SN - 1747-4930
JO - International Journal of Stroke
JF - International Journal of Stroke
ER -