CT flat sweep predicts the expansion of cerebral hemorrhage hematoma and BAT scoring method

Ref: Morotti A, et alStroke2018 May;49 (5): 1163-1169doi: 10.1161/STROKEAHA.117.020138Epub 2018 Apr 18.)cerebral hemorrhage is a common emergency disease in neurosurgery, with a fatality rate of up to 40% in 1 month and severe neurological dysfunction left behind in most patientsHematoma size is the key to the factors that affect the patient's prognosisAfter the initial bleeding of about half of patients with cerebral hemorrhage, the hematoma may continue to expandIt is especially important to predict the increase of hematoma effectively and then interveneCurrent literature reports that CTA's spot sign is a predictor of cerebral hemorrhagic hematoma expansion (hematoma expansion,HE)However, due to the operational requirements of CTA, even in developed countries, more than 80% of patients are unable to get A CTA test at the time of admissionAs a result, there is a study of the increase of cerebral hemorrhage hematoma using CT flat sweep imaging (noncontrast computed dinography, NCCT)NCCT corresponding indicators are mixed signs, black hole signs, island signs and liquid equalityAndrea Morotti of the Stroke Unit of the IRCCS Mondino Foundation in Pavia, Italy, and others, through an analysis of cases of cerebral hemorrhage in several medical departments, proposed that THE BAT scoring method be used to predict the risk of an increase in hematoma during the acute period of cerebral hemorrhage, published in the May 2018 issue of Strokebased on clinical and imaging data from 344 patients with cerebral hemorrhage at Massachusetts General Hospital in Boston,developed a BAT score to predict the risk of hemorrhage acute hemorrhage Then, clinical and imaging data were used in 344 patients in the ATACH-II clinical trial and 241 patients in the PREDICT clinical trial to verify the effectiveness of the BAT score NCCT predicts HE indicators, including black hole signs, mixed signs, hematoma shape, hematoma density, and fluid level Hematoma enlargement means a 6mL increase in hematoma volume or a 33% increase in volume The researchers first used the guide method to establish a simulation sample, selected the prediction indicator, further applied the multivariable logistic regression method to verify the validity of the prediction indicator, and set the scoring standard study found that blend sign (
OR-3.09;95% CI, 1.49-6.40; P-0.002), Black Hole Signs (intrahematoma Hypodensity) (OR-4.54; 95% CI, 2.44-8.43 P 0.0001) and the time of onset to NCCT 2.5 hours (OR s 3.73; 95% CI, 1.86-7.51; P-0.0002) are independent risk factors for predicting brain haemorrhage Based on the above indicators, the author proposes a BAT score, i.e a 5-point scoring method (Figure 1, Table 1) Figure 1 A.CT flat sweep shows mixed signs of cerebral hemorrhage (the area shown by the arrow); mixed signs refer to the high and low density areas in hematoma that are adjacent and clearly bounded, with densities varying by at least 18HU, and low density areas are not enveloped by high-density areas B.CT flat sweep scans the manifestations of black hole signs of cerebral hemorrhage (the site indicated by the arrow); black hole disease refers to the low density cooker with a clear boundary in the hematoma density zone, with a CT value of at least 28HU smaller than the surrounding hematoma region Table 1 BAT score sheet from NCCT The total score of is 5 points the use of c statistic to evaluate the effectiveness of BAT scores in 344 cases of cerebral hemorrhage in single-center patients, with c statistic valueof 0.77 (95% CI, 0.70-0.83); The c statistic values are 0.65 (95% CI, 0.61-0.68) and 0.70 (95% CI, 0.64-0.77), respectively, indicating the value of BAT scoring The sensitivity and specificity of the predicted expansion of cerebral haemorrhagic hematoma were 0.50 and 0.89, respectively, when the BAT score was 3 the authors believe that the BAT score has good sensitivity and specificity to the prediction of hematoma enlargement after brain haemorrhage The use of CT flat sweep to judge the expansion of cerebral hemorrhage hematoma is effective and simple and convenient (The of Neurosurgery of the First Hospital affiliated with Harbin Medical University, Wu Pei compiled, Professor Wang Zhiqiu , of Huashan Hospital affiliated with Fudan University, revised, editor-in-chief of "Outside Information" and professor Chen Chengcheng professor of The Outside Information, affiliated with Fudan University)