Validation of the Black-&-White sign to predict intracerebral hematoma expansion in the multi-center PREDICT study cohort

Umberto Pensato, Koji Tanaka, Johanna M. Ospel, Richard I. Aviv, David Rodriguez-Luna, Micheal D. Hill, Carlos A. Molina, Yolanda Silva Blas, Jean Martin Boulanger, Gubitz Gord, Rohit Bhatia, Vasantha Padma, Jayanta Roy, Imanuel Dzialowski, Carlos S. Kase, Adam Kobayashi, Dar Dowlatshahi, Andrew M. Demchuk*

*Autor corresponent d’aquest treball

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Resum

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.

Idioma originalAnglès
RevistaInternational Journal of Stroke
DOIs
Estat de la publicacióAcceptada/en premsa - 2025
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