The comparative study of island sign and the spot sign in predicting short-term prognosis of patients with intracerebral hemorrhage

Highlights

• It is the first study of the comparison between island sign and spot sign in ICH.

• The island sign was reported in a relatively large number of ICH patients undergoing CTA.

• The prognostic value of NCCT island sign and CTA spot sign was discussed.

• This study also reported the predictors for short-term poor prognosis and early hematoma expansion.

Abstract

Objectives: It is well known that early hematoma expansion is associated with short-term prognosis of patients with intracranial hemorrhage (ICH). And spot sign is recognized as a reliable computed tomography angiography (CTA) predictor for early hematoma expansion. Recently, island sign is also reported as a novel computed tomography (CT) predictor for early hematoma growth. Here, we compared the predictive abilities of these two signs for short-term outcomes of ICH patients.

Patients and Methods: All the ICH patients were retrospectively identified. Clinical characteristics and radiological parameters were obtained from electronic medical records. Hematoma expansion, spot sign and island sign were assessed by two senior neurologists according to the initial and follow-up CT scans. 3-months prognoses were estimated according to Glasgow outcome scale (GOS). Multivariate logistic regression analyses were employed to explore the associations of short-term prognosis on island sign, spot sign and other clinical variables.

Results: There were 283 ICH patients included. 113 of them presented with early hematoma expansions. 66 of them exhibited island sign, while spot sign occurred in 85 patients. Univariate analyses demonstrated that GCS score at admission (OR: 0.464, 95%CI: 0.395–0.547), hematoma volume (OR:1.062, 95%CI: 1.041–1.083), interventricular extension(OR:9.528, 95%CI: 3.915–23.187), island sign (OR: 4.595, 95%CI: 2.404–8.784) and spot sign (OR: 4.052, 95%CI: 2.297–7.147) were correlated with 3-months morbidity. Moreover, multivariate logistic regression analyses further revealed that both spot sign (OR: 3.413, 95%CI: 1.570–7.422) and island sign (OR: 7.564, 95%CI: 2.969–19.273) were strongly associated with 3-months poor outcome and have comparable predictive values (AUC: 0.636 vs. 0.622, P = .58). However, spot sign exhibited a superior predictive ability for 3-months mortality compared to island sign (OR: 2.713, 95%CI: 1.570–4.217 vs. OR: 2.362, 95%CI: 1.238–3.899, AUC: 0.700 vs. 0.603, P < .01).

Conclusions: Island sign is not just a convenient and reliable predictor for short-term prognosis of ICH patients, but also could be used as an indicator for accurate diagnosis and aggressive treatment.

Introduction

Spontaneous Intracerebral hemorrhage (ICH) accounts for approximately 10%–30% of stroke. It is life threatening and carries high incidence of morbidity and mortality [1]. Previously studies reported that early hematoma expansion was occurring in 30% of ICH patients, which could induce poor outcomes and mortality [2,3]. Compared with hematoma size and site, hematoma growth is a potentially modifiable prognostic factor. Consequently, the predictive ability of imaging features for early hematoma expansion has attracted an ocean of attentions in recent years [4]. Some researchers have identified CT angiography (CTA) spot sign as a good predictor for hematoma growth and unfavorable outcome in ICH patients [[5], [6], [7], [8]]. However, in China, CTA remains unavailable to perform within few hours after ICH onset, especially the financial-challenged area. Thus, non-contrast CT (NCCT) imaging markers are more convenient and reasonable for predicting early hematoma expansion and prognosis up to date. Recently, Li et al. [9] have reported a novel NCCT predictor termed as island sign, which exhibited an excellent predictive ability for early hematoma expansion and poor outcome in 252 patients with ICH. Our previously study evaluated the predictive value of the imaging signs for hematoma expansion [10]. Nevertheless, the different between spot sign and island sign in predicting short-term prognosis has never been explored under the same cohort of patients with ICH. Here, based on the same group of patients with ICH, we evaluated the predictive abilities of both spot sign and the island sign for 3-months mortalities and morbidities of patients with ICH, as well as their predictive efficiency.