Abstract: Objective To explore the value of CT island sign, black hole sign and their combined signs in predicting
early hematoma enlargement (HE) in patients with primary intracerebral hemorrhage. Methods A total of 328 patients with
primary intracerebral hemorrhage were retrospectively collected. They were divided into HE group (100 cases) and non-HE
group (228 cases) according to the presence of the early HE. The related clinical data and imaging characteristics (island
sign, black hole sign, and island sign/black hole sign) were collected, and the above factors were compared between the two
groups. The Logistic regression analysis was used for the significant factors in the two groups. The consistency of
interpretation of imaging signs was analyzed by Kappa consistency. The clinical values of the three signs in predicting the
early HE compared. Results The proportion values of admission systolic blood pressure, initial hematoma volume, history
of hypertension, island sign, black hole sign, and island sign/black hole sign were higher in the HE group than those in the
non-HE group (P＜0.05). The admission GCS score was lower in the HE group than that in the non-HE group (P＜0.05).
Logistic regression analysis showed that the lower admission GCS, island sign, black hole sign, and island sign/black hole
sign were all independent risk factors for the early HE (P＜0.05). The two doctors had high consistency in the interpretation
of the island sign, black hole sign and island sign/black hole sign. The Kappa values were 0.858, 0.881 and 0.896,
respectively. The sensitivity values of the island sign, black hole sign and island sign/black hole sign for the predicting early
HE were 32.0%, 93.0%, 29.0%, and specificity were 93.9%, 49.0%, 88.2%. The Youden index values were 0.250, 0.229 and
0.372 respectively; the Youden index of the island sign/black hole sign was larger than that of the island sign and black hole
sign. Conclusion Compared with the single sign, the island sign combined with the black hole sign shows a better
predictive ability for the early HE in primary intracerebral hemorrhage patients.

Key words: cerebral hemorrhage, tomography, X-Ray computed, hematoma enlargement, island sign, black hole sign