J Korean Soc Geriatr Neurosurg > Volume 16(1); 2020 > Article
Journal of Korean Society of Geriatric Neurosurgery 2020;16(1):12-19.
DOI: https://doi.org/10.51638/jksgn.20.00087    Published online September 30, 2020.
Efficacy of the Combined Swirl Sign with Blend Sign for Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage in Elderly Patients
In Hyoung Lee, Jong Il Choi
Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
고령의 자발성 뇌내출혈 환자에서 Swirl Sign과 Blend Sign 동반출현의 혈종 증가 예측인자로서의 효용성
이인형, 최종일
한림대학교 의과대학 강남성심병원 신경외과학교실
Correspondence:  Jong Il Choi, Tel: +82-2-829-5179, Fax: +82-2-829-0219, 
Email: thlthd@korea.ac.kr
This study was aimed at investigating the relationship of the concurrent appearance of the blend and swirl signs on non-contrast brain computed tomography (NCCT) with hematoma expansion (HE) in the elderly (≥65 years) patients with spontaneous intracerebral hemorrhage (ICH). Further, we intended to prove the effectiveness as a predictor of the concurrent appearance of the blend and swirl signs for HE by comparing it with that of the spot sign.
We retrospectively enrolled 201 elderly with spontaneous ICH at their initial visits to the emergency room from March, 2014, to December, 2018. Inclusion criteria were NCCT and CT angiography (CTA) scans within 4 h of developing symptoms and follow-up NCCT. Exclusion criteria were clear pre-existing causes of cerebral hemorrhage, emergency surgery, and death before follow-up NCCT. Factors possibly associated with HE were isolated for a comparison analysis.
Appearance rates of the spot sign, swirl sign, and concurrent appearance of the swirl and blend signs were significantly higher in the HE group compared to the non HE group. According to the multivariate logistic regression on HE, the independent variables that had a statistically significant effect on the prediction of HE were the spot sign (p= 0.001), concurrent appearance of swirl and blend signs (p=0.001), and initial hematoma volume (p=0.023).
The concurrent appearance of the blend and swirl signs can be a useful predictor of HE in elderly patients who have been diagnosed with spontaneous ICH but cannot undergo CTA.
Key Words: Blend sign, Hematoma expansion, Noncontrast computed tomography, Spontaneous intracerebral hemorrhage, Spot sign, Swirl sign

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