To compare the predictive values of swirl sign and black hole sign on CT scanning in early hematoma expansion in spontaneous intracerebral hemorrhage (SICH) patients.

Two hundred and ten firstly diagnosed SICH patients, admitted to our hospital from January 2012 to December 2018, were enrolled in the study. All patients were divided into hematoma expansion and non-hematoma expansion group according to whether early hematoma expansion appeared; and they were also divided into positive imaging sign group and negative imaging sign group according to whether imaging signs appeared; the clinical and imaging data were compared between these groups, respectively. The accuracies of swirl sign and black hole sign in predicting early hematoma expansion were analyzed using receiver operator characteristic (ROC) curve. Multivariate Logistic regression analysis was performed to determine the independent risk factors for early hematoma expansion.

(1) In the 57 patients with early hematoma expansion, 21 (36.8%) had swirl sign, and 17 (29.8%) had black hole sign; in the 153 patients without hematoma expansion, 12 (7.8%) had swirl sign and 22 (14.4%) had black hole sign; the differences between the two groups were statistically significant (P<0.05). As compared with those in the non-hematoma expansion group, the admission systolic blood pressure increased significantly and number of patients with intraventricular hemorrhage was significantly larger in the hematoma expansion group (P<0.05). (2) There were no statistical differences in clinical and imaging data between the patients with swirl sign (n=33) and patients without swirl sign (n=177, P>0.05); the hematoma volume in patients with black hole sign (n=39) was significantly increased as compared with that in patients without black hole sign (n=171, P<0.05), and there were no statistical differences in other clinical and imaging data between patients with and without black hole sign (P>0.05). (3) The areas under ROC curve of swirl sign, black hole sign, and "swirl sign combined with black hole sign" were 0.645, 0.577, and 0.570, respectively. (4) Multivariate Logistic regression analysis showed that admission systolic blood pressure, swirl sign and black hole sign were independent risk factors for early hematoma expansion (P<0.05).

In comparison to black hole sign and "swirl sign combined with black hole sign" , the swirl sign has higher predictive value in early hematoma expansion in ICH patients.

Spontaneous intracerebral hemorrhage; Hematoma expansion; Swirl sign; Black hole sign