Frontiers in neurology · 2026
The "brush sign": a novel and accessible CT marker for hematoma expansion in hypertensive intracerebral hemorrhage.
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Wang Jing, Wu Chuyue, Chen Shengli, Cheng Qisheng, Ran Yuxin, He Lei, Yang Zhenjie, Xie Peng, Li Wangwen
Аннотация
OBJECTIVE: Patients with hypertensive intracerebral hemorrhage (ICH) are at risk for hematoma expansion (HE) in the early stages. Although the "spot sign" on computed tomography angiography (CTA) is a useful predictor of HE, the method has limitations, including low sensitivity and difficulty in identification. This study introduces a more recognizable and accessible "brush sign" on plain CT images following CTA examination and compares its effectiveness with the "spot sign" in predicting HE.
METHODS: Hypertensive ICH patients admitted to the Advanced Stroke Center of the hospital from January 2023 to December 2024 were retrospectively analyzed. This study evaluated sequential plain CT neuroimaging after CTA in these patients, defined the "brush sign," and identified two morphological types, namely "isolated" and "continuous." This study analyzed the correlations between the CTA "spot sign," "brush sign," and other clinical data with HE. Finally, the HE prediction efficiency of the "brush sign" and "spot sign" was compared using the receiver operating characteristic (ROC) analysis.
RESULTS: A total of 162 hypertensive ICH patients were enrolled, with 45 patients (27.8%) exhibiting HE. The spot, isolated brush, and continuous brush signs were observed in 48 (29.6%), 12 (7.4%), and 43 (26.5%) cases, respectively. The spot sign (p = 0.017, OR = 3.943, 95% CI [1.289-12.617]) and continuous brush sign (p = 0.016, OR = 3.997, 95% CI [1.302-12.787]) were independent HE predictors. The ROC analysis showed that the continuous brush sign (AUC = 0.895, specificity = 0.949, sensitivity = 0.862) and its combination with the spot sign (AUC = 0.900, specificity = 0.932, sensitivity = 0.852) predicted HE with high accuracy.
CONCLUSION: The "brush sign" can independently predict early HE in hypertensive ICH patients. The use of the continuous "brush sign" either alone or in combination with the "spot sign" demonstrates high accuracy for predicting HE. These markers can be used to stratify HE risk and suggest early intervention strategies for hypertensive ICH patients.
METHODS: Hypertensive ICH patients admitted to the Advanced Stroke Center of the hospital from January 2023 to December 2024 were retrospectively analyzed. This study evaluated sequential plain CT neuroimaging after CTA in these patients, defined the "brush sign," and identified two morphological types, namely "isolated" and "continuous." This study analyzed the correlations between the CTA "spot sign," "brush sign," and other clinical data with HE. Finally, the HE prediction efficiency of the "brush sign" and "spot sign" was compared using the receiver operating characteristic (ROC) analysis.
RESULTS: A total of 162 hypertensive ICH patients were enrolled, with 45 patients (27.8%) exhibiting HE. The spot, isolated brush, and continuous brush signs were observed in 48 (29.6%), 12 (7.4%), and 43 (26.5%) cases, respectively. The spot sign (p = 0.017, OR = 3.943, 95% CI [1.289-12.617]) and continuous brush sign (p = 0.016, OR = 3.997, 95% CI [1.302-12.787]) were independent HE predictors. The ROC analysis showed that the continuous brush sign (AUC = 0.895, specificity = 0.949, sensitivity = 0.862) and its combination with the spot sign (AUC = 0.900, specificity = 0.932, sensitivity = 0.852) predicted HE with high accuracy.
CONCLUSION: The "brush sign" can independently predict early HE in hypertensive ICH patients. The use of the continuous "brush sign" either alone or in combination with the "spot sign" demonstrates high accuracy for predicting HE. These markers can be used to stratify HE risk and suggest early intervention strategies for hypertensive ICH patients.