Intracerebral hemorrhage (ICH) is an important cause of death and disability. This study aimed to explore the imaging indicators identifying hematoma expansion in primary ICH and to provide a basis for its clinical treatment.

Material and methods:
Hematoma expansion was evaluated by plain computed tomography (CT) scan and multi-detector-row CT angiography (MDCTA).

This study included a total of 203 patients with intracerebral hemorrhage. The size of the hematoma at the time of admission was 32.5–92.3 mL (average, 45.5 mL). Original or reconstructed MDCTA images with contrast extravasation were available in 35 cases (17.2%). Patients were divided into two groups based on whether or not hematoma expansion had occurred: hematoma expansion group (n = 87) and no hematoma expansion group (n = 116). Patients with spot signs in the two groups were 37.93% and 3.45%, respectively, and those with spot sign ± blend sign ± black hole sign ± island sign (%) were 48.30% and 1.72%, respectively, with significant statistical differences. The sensitivity, specificity, and positive and negative predictive values of hematoma enlargement were 37.93%, 98.27%, and 94.29% and 67.86%, respectively. The sensitivity, specificity, and positive and negative predictive values of blend density sign ± irregular sign in predicting hematoma enlargement in ICH patients were 97.7%, 76.7%, and 75.9% and 97.8%, respectively.

Blend density sign ± irregular sign can be used as substitute signs. The more irregular and uneven density the hematoma, the more likely it is that the hematoma will be enlarged.

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