Meta-Analysis of Predictive Significance of the Black Hole Sign for Hematoma Expansion in Intracerebral Hemorrhage

2018 ◽  
Vol 115 ◽  
pp. e711-e716 ◽  
Author(s):  
Jun Zheng ◽  
Zhiyuan Yu ◽  
Rui Guo ◽  
Hao Li ◽  
Chao You ◽  
...  
Keyword(s):  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Hematoma Expansion

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

2021 ◽  
pp. 174749302110616
Author(s):  
Arba Francesco ◽  
Rinaldi Chiara ◽  
Boulouis Gregoire ◽  
Fainardi Enrico ◽  
Charidimou Andreas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Significant Risk ◽  
Irregular Shape ◽  
Hematoma Expansion ◽  
Logistic Regression Models ◽  
Noncontrast Computed Tomography

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

Black Hole Sign on Noncontrast Computed Tomography in Predicting Hematoma Expansion in Patients with Intracerebral Hemorrhage: A Meta-analysis

2020 ◽  
Vol 16 (7) ◽  
pp. 878-886
Author(s):  
Yilin Chen ◽  
Lu Tian ◽  
Longlun Wang ◽  
Yong Qin ◽  
Jinhua Cai
Keyword(s):  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Publication Bias ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Meta Analysis ◽  
High Specificity ◽  
Hematoma Expansion ◽  
Likelihood Ratios ◽  
Sensitivity Specificity

Background: Black hole sign represents a novel imaging marker for predicting hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH). Several previous studies have reported the accuracy of black hole sign in predicting HE, but the accuracy was variable. We performed a meta-analysis to systematically assess the accuracy of black hole sign in predicting HE in patients with ICH. Methods: A systematic search was performed to identify relevant English and Chinese articles (from inception to January 2019). All studies on the accuracy of black hole sign in predicting HE in patients with ICH were included. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated. Pooling was conducted using the bivariate generalized linear mixed model. Forest plots and a summary receiver operator characteristic plot were generated. We used I² to test heterogeneity and investigated the source of heterogeneity by meta-regression. Publication bias was assessed by Deeks’ funnel plot asymmetry test. Results: A total of 6 studies with 1876 patients were included in this meta-analysis. The pooled sensitivity, specificity, and positive and negative likelihood ratios of black hole sign for predicting HE were 0.30, 0.93, 4.00 and 0.75, respectively. The area under the curve (AUC) was 0.83. The studies had substantial heterogeneity (I²=89.00%, 95% CI 78.00-100.00). Low risk of publication bias was detected. Conclusion: Black hole sign is a useful imaging marker with high specificity in predicting hematoma expansion in patients with intracerebral hemorrhage.

scholarly journals Evaluating Hematoma Expansion Scores in Acute Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1305-1308 ◽  
Author(s):  
Vignan Yogendrakumar ◽  
Margaret Moores ◽  
Lindsey Sikora ◽  
Michel Shamy ◽  
Tim Ramsay ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
High Performance ◽  
Meta Analysis ◽  
Descriptive Analysis ◽  
Hematoma Expansion ◽  
Cochrane Central Register ◽  
Spontaneous Intracerebral Hemorrhage ◽  
C Statistic ◽  
Point Increase ◽  
Central Register

Background and Purpose— In acute spontaneous intracerebral hemorrhage, multiple hematoma expansion scores have been proposed for use in clinical trial environments. We performed a systematic scoping review to identify all existing hematoma expansion scores and describe their development, validation, and relative performance. Methods— Two reviewers searched MEDLINE, PUBMED, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for studies that derived or validated a hematoma expansion prediction score in adults presenting with spontaneous intracerebral hemorrhage. A descriptive analysis of the extracted data was performed, focusing on score development techniques and predictive capabilities. Results— Of the 14 434 records retrieved, 15 studies met inclusion criteria and 10 prediction scores were identified. Validation analysis using independent samples was performed in 9 studies on 5 scores. All derivation studies reported high performance with C statistics ranging from 0.72 to 0.93. In validation, the C-statistic range was broader with studies reporting 0.62 to 0.77. For every score, the risk of expansion increased with each point increase, although patients with high scores were rare. Conclusions— At present, 10 hematoma expansion scores have been developed, of which 5 have been externally validated. Real-world performance in validation studies was lower than performance in derivation studies. Data from the current literature are insufficient to support a meaningful meta-analysis.

scholarly journals P.146 Non-contrast CT markers of intracerebral hemorrhage expansion: a predictive accuracy and reliability study

2021 ◽  
Vol 48 (s3) ◽  
pp. S61-S62
Author(s):  
A Nehme ◽  
M Panzini ◽  
C Ducroux ◽  
MT Maallah ◽  
C Bard ◽  
...  
Keyword(s):  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Predictive Accuracy ◽  
Hematoma Expansion ◽  
Rater Agreement ◽  
Fluid Level ◽  
Reliability Study ◽  
Observer Reliability ◽  
Absolute Growth ◽  
Contrast Ct

Background: We evaluated (1) the predictive accuracy and (2) multi-observer reliability of non-contrast CT markers of hematoma expansion (HE). Methods: In 124 patients with spontaneous intracerebral hemorrhage, two investigators documented the presence of six density (Barras density, hypodensity, black hole, swirl, blend, fluid level) and three shape (Barras shape, island, satellite) expansion markers, with discrepancies resolved by a third rater. We defined HE as any one of (1) >6 mL absolute or >33% relative growth of the intraparenchymal hematoma or (2) an absolute growth of >1 mL or new development of intraventricular hematoma. A subsample of 60 patients was used for the inter-observer reliability study in 13 raters. Seven raters participated in the intra-rater study. Results: The sensitivity of markers for HE varied between 4% (fluid level) and 78% (satellite), while specificity ranged from 37% (swirl) to 97% (black hole). Almost perfect inter-rater agreement was observed for the swirl (0.89) and fluid level (0.83) markers, while hypodensity (0.65) showed substantial agreement. Only the blend and fluid level markers achieved substantial intra-rater agreement (> 0.6) in all raters. Conclusions: Non-contrast CT markers of HE showed lower reliability and predictive accuracy than previously reported. Future studies should address means to improve NCCT-based HE prediction.

scholarly journals Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Gengzhao Ye ◽  
Shuna Huang ◽  
Renlong Chen ◽  
Yan Zheng ◽  
Wei Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Clinical Laboratory ◽  
Characteristic Curve ◽  
Hematoma Expansion ◽  
Hematoma Volume ◽  
Absolute Increase ◽  
Poor Outcome ◽  
Perihematomal Edema

Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions.Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729).Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016–1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26–15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84–31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03–0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P < 0.001, β = 21.62 95% CI 10.10–33.15).Conclusions: An increase of PHE volume >7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.

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