Hematoma expansion (HE) is strongly associated with serious neurological deficits after intracerebral hemorrhage (ICH). We aim to explore whether the number of black hole signs (BHS) might predict HE in patients with ICH. We retrospectively collected a total of 198 patients who suffered from spontaneous ICH at The Second Affiliated Hospital of Chongqing Medical University between August 2015 and August 2024. The number of BHS on admission head non-contrast computed tomography (NCCT) performed within 6 h after onset of symptoms was calculated. HE was determined based on follow-up CT within 48 h. Logistic regression analyses were applied to assess the association of clinical and radiological parameters with HE. Subgroup analyses were performed to exclude confounding factors. In addition, the number of BHS and other factors that may contribute to HE prediction was analyzed using receiver operating characteristic (ROC) analysis and decision curve analysis (DCA). We retrospectively analyzed clinical and imaging data from 198 patients with spontaneous ICH. The odds ratio (OR) of the number of BHS in predicting HE was 7.539 (95% CI 3.427 to 16.588, P < 0.001) after adjusted. The area under the ROC curve of the number of BHS was 0.737, which showed high value in predicting HE. The number of BHS on admission NCCT provides the first exploratory dose-dependent predictor of HE, enabling individualized risk stratification.
Keywords: Black hole sign; Hematoma expansion; Intracerebral hemorrhage; Predictive value; Tomography, x-ray computed.
© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.