Evaluating the Predictive Value of Island Sign and Spot Sign for Hematoma Expansion in Spontaneous Intracerebral...

Hematoma expansion (HE) is closely related to poor outcome in spontaneous intracerebral hemorrhage (sICH). Island sign (IS) is a novel HE predictor based on noncontrast computed tomography (NCCT). This study is aimed to confirm the accuracy of IS for predicting HE and compare it to the spot sign (SS) on computed tomography angiography (CTA).

Patients with sICH and initial CTA within 6 hours after onset and follow-up NCCT within 24 hours after initial CTA were included. IS and SS were screened by 2 independent readers. The sensitivity and specificity were evaluated for both signs. Receiver-operator analysis was conducted to assess the accuracy of both signs for predicting HE.

This study included 165 patients. IS was found in 33 (20.0%) patients, and SS was identified in 42 (25.5%) patients. In the 41 patients with HE, 19 (46.3%) had IS and 26 (63.4%) had SS. The sensitivity and specificity of IS were 46.3% and 88.7%, respectively. In contrast, the sensitivity and specificity of SS were 63.4% and 87.1%, respectively. The areas under the curve of IS and SS were 0.675 and 0.753, respectively (P = 0.275).

IS is independently associated with HE. Although the accuracy of IS for predicting HE is lower than SS, it can be an alternative predictor if CTA cannot be performed.