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Objective: This study was aimed at investigating the relationship of the concurrent appearance of the blend and swirl signs on non-contrast brain computed tomography (NCCT) with hematoma expansion (HE) in the elderly (≥65 years) patients with spontaneous intracerebral hemorrhage (ICH). Further, we intended to prove the effectiveness as a predictor of the concurrent appearance of the blend and swirl signs for HE by comparing it with that of the spot sign. Methods: We retrospectively enrolled 201 elderly with spontaneous ICH at their initial visits to the emergency room from March, 2014, to December, 2018. Inclusion criteria were NCCT and CT angiography (CTA) scans within 4 h of developing symptoms and follow-up NCCT. Exclusion criteria were clear pre-existing causes of cerebral hemorrhage, emergency surgery, and death before follow-up NCCT. Factors possibly associated with HE were isolated for a comparison analysis. Results: Appearance rates of the spot sign, swirl sign, and concurrent appearance of the swirl and blend signs were significantly higher in the HE group compared to the non HE group. According to the multivariate logistic regression on HE, the independent variables that had a statistically significant effect on the prediction of HE were the spot sign (p= 0.001), concurrent appearance of swirl and blend signs (p=0.001), and initial hematoma volume (p=0.023). Conclusion: The concurrent appearance of the blend and swirl signs can be a useful predictor of HE in elderly patients who have been diagnosed with spontaneous ICH but cannot undergo CTA.

Efficacy of the Combined Swirl Sign with Blend Sign for Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage in Elderly Patients