{
    "abstract": "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.\nAcute 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 (\u2a7e6\u2009mL or \u2a7e33%) and severe HE (\u2a7e12.5\u2009mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors.\nThree 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\u2009=\u20090.008), hematoma absolute growth (19.1\u2009mL (interquartile range (IQR)\u2009=\u20096.4-40) vs 3.2\u2009mL (IQR= 0-23.3), p\u2009=\u20090.018), and hematoma relative growth (92% (IQR\u2009=\u200916-151%) vs 24% (IQR= 0-69%), p\u2009=\u20090.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR)\u2009=\u20097.83 (95% confidence interval (CI)\u2009=\u20092.93-20.91)) and severe HE (adjusted OR\u2009=\u20095.67 (95% CI\u2009=\u20092.41-13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR\u2009=\u200961.7-90.1) for HE. Inter-rater agreement was moderate (k\u2009=\u20090.54).\nThe B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.",
    "authors": [
        {
            "affiliation": "IRCCS Humanitas Research Hospital, Milan, Italy.\nDepartment of Biomedical Sciences, Humanitas University, Milan, Italy.\nDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.",
            "firstname": "Umberto",
            "initials": "U",
            "lastname": "Pensato"
        },
        {
            "affiliation": "Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.",
            "firstname": "Koji",
            "initials": "K",
            "lastname": "Tanaka"
        },
        {
            "affiliation": "Department of Radiology, University of Calgary, Calgary, AB, Canada.",
            "firstname": "Johanna M",
            "initials": "JM",
            "lastname": "Ospel"
        },
        {
            "affiliation": "Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada.",
            "firstname": "Richard I",
            "initials": "RI",
            "lastname": "Aviv"
        },
        {
            "affiliation": "Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain.",
            "firstname": "David",
            "initials": "D",
            "lastname": "Rodriguez-Luna"
        },
        {
            "affiliation": "Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.\nDepartment of Radiology, University of Calgary, Calgary, AB, Canada.",
            "firstname": "Micheal D",
            "initials": "MD",
            "lastname": "Hill"
        },
        {
            "affiliation": "Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain.",
            "firstname": "Carlos A",
            "initials": "CA",
            "lastname": "Molina"
        },
        {
            "affiliation": "Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.",
            "firstname": "Yolanda",
            "initials": "Y",
            "lastname": "Silva Blas"
        },
        {
            "affiliation": "Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Longueuil, Canada.",
            "firstname": "Jean-Martin",
            "initials": "JM",
            "lastname": "Boulanger"
        },
        {
            "affiliation": "Department of Neurology, Dalhousie University, Halifax, NS, Canada.",
            "firstname": "Gubitz",
            "initials": "G",
            "lastname": "Gord"
        },
        {
            "affiliation": "Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.",
            "firstname": "Rohit",
            "initials": "R",
            "lastname": "Bhatia"
        },
        {
            "affiliation": "Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.",
            "firstname": "Vasantha",
            "initials": "V",
            "lastname": "Padma"
        },
        {
            "affiliation": "Apollo Gleneagles Hospitals, Kolkata, India.",
            "firstname": "Jayanta",
            "initials": "J",
            "lastname": "Roy"
        },
        {
            "affiliation": "Department of Neurology, Elblandklinikum Meissen Academic Teaching Hospital of the Technische University, Dresden, Germany.",
            "firstname": "Imanuel",
            "initials": "I",
            "lastname": "Dzialowski"
        },
        {
            "affiliation": "Department of Neurology, Boston Medical Center, Boston, MA, USA.",
            "firstname": "Carlos S",
            "initials": "CS",
            "lastname": "Kase"
        },
        {
            "affiliation": "Interventional Stroke and Cerebrovascular Treatment Center and 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.",
            "firstname": "Adam",
            "initials": "A",
            "lastname": "Kobayashi"
        },
        {
            "affiliation": "Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, ON, Canada.",
            "firstname": "Dar",
            "initials": "D",
            "lastname": "Dowlatshahi"
        },
        {
            "affiliation": "Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.\nDepartment of Radiology, University of Calgary, Calgary, AB, Canada.\nHotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.",
            "firstname": "Andrew M",
            "initials": "AM",
            "lastname": "Demchuk"
        }
    ],
    "conclusions": "The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.",
    "copyrights": null,
    "doi": "10.1177/17474930241307466",
    "journal": "International journal of stroke : official journal of the International Stroke Society",
    "keywords": [
        "Hemorrhagic stroke",
        "active bleeding",
        "hemostatic therapy",
        "intracranial hemorrhage",
        "radiological markers",
        "spot sign",
        "\u201cblack and white\u201d"
    ],
    "methods": null,
    "publication_date": "2024-12-03",
    "pubmed_id": "39623688",
    "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\u2009=\u20090.008), hematoma absolute growth (19.1\u2009mL (interquartile range (IQR)\u2009=\u20096.4-40) vs 3.2\u2009mL (IQR= 0-23.3), p\u2009=\u20090.018), and hematoma relative growth (92% (IQR\u2009=\u200916-151%) vs 24% (IQR= 0-69%), p\u2009=\u20090.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR)\u2009=\u20097.83 (95% confidence interval (CI)\u2009=\u20092.93-20.91)) and severe HE (adjusted OR\u2009=\u20095.67 (95% CI\u2009=\u20092.41-13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR\u2009=\u200961.7-90.1) for HE. Inter-rater agreement was moderate (k\u2009=\u20090.54).",
    "title": "Validation of the Black-&-White sign to predict intracerebral hematoma expansion in the multi-center PREDICT study cohort.",
    "xml": "<Element 'PubmedArticle' at 0x7885043799e0>"
}