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Swirl sign in intracerebral haemorrhage: definition, prevalence, reliability and prognostic value

Selariu, Eufrozina LU ; Zia, Elisabet LU ; Brizzi, Marco LU and Abul-Kasim, Kasim LU (2012) In BMC Neurology 12(109).
Abstract
Background: Swirl sign has previously been described in epidural hematomas as areas of low attenuation, radiolucency or irregular density. The aims of this study were to describe swirl sign in ICH, study its prevalence, study the reliability of the subjective evaluation on computed tomography (CT), and to explore its prognostic value. Methods: CTs of 203 patients with ICH were retrospectively evaluated for the presence of swirl sign. Association between swirl sign and different clinical and radiological variables was studied. Results: Inter-and intraobserver agreement with regard to the occurrence of swirl sign was substantial (kappa 0.80) and almost perfect (kappa 0.87), respectively. Swirl sign was found in 30% of the study population.... (More)
Background: Swirl sign has previously been described in epidural hematomas as areas of low attenuation, radiolucency or irregular density. The aims of this study were to describe swirl sign in ICH, study its prevalence, study the reliability of the subjective evaluation on computed tomography (CT), and to explore its prognostic value. Methods: CTs of 203 patients with ICH were retrospectively evaluated for the presence of swirl sign. Association between swirl sign and different clinical and radiological variables was studied. Results: Inter-and intraobserver agreement with regard to the occurrence of swirl sign was substantial (kappa 0.80) and almost perfect (kappa 0.87), respectively. Swirl sign was found in 30% of the study population. 61% of patients with swirl sign were dead at one month compared with 21% of those with no swirl sign (p < 0.001). Only 19% of patients with swirl sign exhibited favorable outcome at three months compared with 53% of those with no swirl sign (p < 0.001). Patients with swirl sign exhibited larger ICHs with average ICH-volume 52 +/- 50 ml (median 42 ml) compared with 15 +/- 25 ml (median 6) in patients whose CT did not show swirl sign (p < 0.001). Swirl sign was independent predictor of death at one month (p = 0.03; adjusted odds ratio 2.6, 95% CI 1.1 - 6), and functional outcome at three months (p = 0.045; adjusted odds ratio 2.6, 95% CI 1.02 - 6.5). Conclusions: As swirl sign showed to be an ominous sign, we recommend identification of this sign in cases of ICHs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Swirl sign, Computed tomography, Reliability, Functional outcome, Haemorrhage volume
in
BMC Neurology
volume
12
issue
109
publisher
BioMed Central
external identifiers
  • wos:000312408900001
  • scopus:84866544607
ISSN
1471-2377
DOI
10.1186/1471-2377-12-109
language
English
LU publication?
yes
id
c73f0312-06c1-45df-845d-04d3a25c81f4 (old id 3371963)
date added to LUP
2013-02-01 06:59:06
date last changed
2017-09-10 04:02:19
@article{c73f0312-06c1-45df-845d-04d3a25c81f4,
  abstract     = {Background: Swirl sign has previously been described in epidural hematomas as areas of low attenuation, radiolucency or irregular density. The aims of this study were to describe swirl sign in ICH, study its prevalence, study the reliability of the subjective evaluation on computed tomography (CT), and to explore its prognostic value. Methods: CTs of 203 patients with ICH were retrospectively evaluated for the presence of swirl sign. Association between swirl sign and different clinical and radiological variables was studied. Results: Inter-and intraobserver agreement with regard to the occurrence of swirl sign was substantial (kappa 0.80) and almost perfect (kappa 0.87), respectively. Swirl sign was found in 30% of the study population. 61% of patients with swirl sign were dead at one month compared with 21% of those with no swirl sign (p &lt; 0.001). Only 19% of patients with swirl sign exhibited favorable outcome at three months compared with 53% of those with no swirl sign (p &lt; 0.001). Patients with swirl sign exhibited larger ICHs with average ICH-volume 52 +/- 50 ml (median 42 ml) compared with 15 +/- 25 ml (median 6) in patients whose CT did not show swirl sign (p &lt; 0.001). Swirl sign was independent predictor of death at one month (p = 0.03; adjusted odds ratio 2.6, 95% CI 1.1 - 6), and functional outcome at three months (p = 0.045; adjusted odds ratio 2.6, 95% CI 1.02 - 6.5). Conclusions: As swirl sign showed to be an ominous sign, we recommend identification of this sign in cases of ICHs.},
  author       = {Selariu, Eufrozina and Zia, Elisabet and Brizzi, Marco and Abul-Kasim, Kasim},
  issn         = {1471-2377},
  keyword      = {Swirl sign,Computed tomography,Reliability,Functional outcome,Haemorrhage volume},
  language     = {eng},
  number       = {109},
  publisher    = {BioMed Central},
  series       = {BMC Neurology},
  title        = {Swirl sign in intracerebral haemorrhage: definition, prevalence, reliability and prognostic value},
  url          = {http://dx.doi.org/10.1186/1471-2377-12-109},
  volume       = {12},
  year         = {2012},
}