Background and Purpose- Blend, black hole, island signs, and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage. We explored the value of these noncontrast computed tomography signs in predicting hematoma expansion and functional outcome in our cohort of intracerebral hemorrhage. Methods- The TICH-2 (Tranexamic acid for IntraCerebral Hemorrhage-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute intracerebral hemorrhage. Baseline and 24-hour computed tomography scans of trial participants were analyzed. Hematoma expansion was defined as an increase in hematoma volume of >33% or >6 mL on 24-hour computed tomography. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome. Results- Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. Five hundred seventy patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of noncontrast computed tomography signs was blend sign, 366 (16.1%); black hole sign, 414 (18.2%); island sign, 200 (8.8%); and hypodensities, 701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53 [95% CI, 1.16-2.03]; P=0.003), black hole (aOR, 2.03 [1.34-3.08]; P=0.001), and hypodensities (aOR, 2.06 [1.48-2.89]; P<0.001) were independent predictors of hematoma expansion on multivariable analysis with adjustment for covariates. Black hole sign (aOR, 1.52 [1.10-2.11]; P=0.012), hypodensities (aOR, 1.37 [1.05-1.78]; P=0.019), and island sign (aOR, 2.59 [1.21-5.55]; P=0.014) were significant predictors of poor functional outcome. Tranexamic acid reduced the risk of hematoma expansion (aOR, 0.77 [0.63-0.94]; P=0.010), but there was no significant interaction between the presence of noncontrast computed tomography signs and benefit of tranexamic acid on hematoma expansion and functional outcome (P interaction all >0.05). Conclusions- Blend sign, black hole sign, and hypodensities predict hematoma expansion while black hole sign, hypodensities, and island signs predict poor functional outcome. Noncontrast computed tomography signs did not predict a better response to tranexamic acid. Clinical Trial Registration- URL: https://www.isrctn.com. Unique identifier: ISRCTN93732214.

中文翻译：

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非对比计算机断层扫描术是急性脑出血中血肿扩大，临床结果和对氨甲环酸反应的预测指标。

背景和目的-混合，黑洞，岛状体征和低密度据报道可预测急性脑出血中血肿的扩大。我们探讨了这些非对比计算机体层摄影术迹象在预测脑出血人群中血肿扩大和功能预后方面的价值。方法-TICH-2（氨甲环酸治疗脑内出血2）是一项前瞻性随机对照试验，探讨了氨甲环酸在急性脑出血中的疗效和安全性。分析了试验参与者的基线和24小时计算机断层扫描。血肿扩大定义为在24小时计算机断层扫描中血肿体积增加> 33％或> 6 mL。功能不良者定义为在第90天时改良的Rankin量表为4至6。进行多变量logistic回归以鉴定血肿扩大和功能预后不良的预测因素。结果-在招募的2325名患者中，有2077名（89.3％）进行了有效的基线和24小时扫描。570名患者（27.4％）发生了血肿扩大，而1259名患者（54.6％）的功能预后较差。非对比计算机断层扫描体征的普遍性是混合体征，366（16.1％）；黑洞征兆414（18.2％）; 岛屿标志，200（8.8％）; 和低密度701（30.2％）。混合符号（调整后的优势比[aOR] 1.53 [95％CI，1.16-2.03; P = 0.003），黑洞（aOR，2.03 [1.34-3.08]; P = 0.001）和低密度（aOR，2.06 [1.48] -2.89]； P <0.001）是多变量分析中血肿扩展的独立预测因子，并需要对协变量进行调整。黑洞征象（aOR，1.52 [1.10-2.11]; P = 0.012），低密度（aOR，1.37 [1。05-1.78]; P = 0.019）和岛征（aOR，2.59 [1.21-5.55]； P = 0.014）是不良功能预后的重要预测指标。氨甲环酸降低了血肿扩大的风险（aOR，0.77 [0.63-0.94]； P = 0.010），但无对比计算机断层显像征的存在与氨甲环酸对血肿扩大和功能预后的益处之间无显着相互作用（P互动均> 0.05）。结论-混合体征，黑洞体征和低密度可预示血肿扩大，而黑洞体征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。014）是功能不良的重要预测指标。氨甲环酸降低了血肿扩大的风险（aOR，0.77 [0.63-0.94]； P = 0.010），但无对比计算机断层显像征的存在与氨甲环酸对血肿扩大和功能结局的益处之间无显着相互作用（P互动均> 0.05）。结论-混合体征，黑洞体征和低密度可预示血肿扩大，而黑洞体征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。014）是功能不良的重要预测指标。氨甲环酸降低了血肿扩大的风险（aOR，0.77 [0.63-0.94]； P = 0.010），但无对比计算机断层显像征的存在与氨甲环酸对血肿扩大和功能结局的益处之间无显着相互作用（P互动均> 0.05）。结论-混合体征，黑洞体征和低密度可预示血肿扩大，而黑洞体征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。但无对比计算机断层扫描体征与氨甲环酸对血肿扩展和功能结局的益处之间无显着相互作用（P相互作用均> 0.05）。结论-混合体征，黑洞体征和低密度可预示血肿扩大，而黑洞体征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。但无对比计算机断层扫描体征与氨甲环酸对血肿扩展和功能结局的益处之间无显着相互作用（P相互作用均> 0.05）。结论-混合体征，黑洞体征和低密度可预示血肿扩大，而黑洞体征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。低密度和低密度可预示血肿扩大，而黑洞征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。低密度和低密度可预示血肿扩大，而黑洞征，低密度和岛状预示功能不良。非对比计算机断层扫描体征不能预测对氨甲环酸有更好的反应。临床试验注册-URL：https：//www.isrctn.com。唯一标识符：ISRCTN93732214。