3D island sign on computed tomography predicts early perihematomal edema expansion and poor outcome in patients with intracerebral hemorrhage

Background and purpose: To determine the prognostics significance of the computed tomography (CT) 3D island sign for predicting early perihematomal edema (PHE) expansion and poor functional outcome in patients pre-senting with intracerebral hemorrhage (ICH).Methods: Between July 2011 and March 2017, patients with intracerebral hemorrhage who had undergone baseline CT within 6 h after ICH symptom onsets and follow-up CT in our hospital were included. Two different readers independently assessed the presence of 3D island sign on admission CT scan of each patient. Multivar-iable logistic regression analysis was used to analyze association between 3D island sign and early peri-hematomal edema expansion and poor functional outcome, separately.Results: A total of 214 patients who met the inclusion criteria were included in our study, 3D island sign was observed in 60 patients (28.0 %) on admission CT scan. The multivariate logistic regression analysis demon-strated that baseline hematoma volume, time to baseline and follow-up CT scans and the presence of 3D island sign were predictors of early PHE expansion. After adjusting for age, baseline hematoma and edema volume, time to baseline and follow-up CT scans, GCS on admission, presence of intraventricular hemorrhage (IVH) and systolic blood pressure, the 3D island sign was an independently imaging marker for poor outcome (OR, 2.803; 95 % confidence interval, 1.189-6.609; P = 0.018).Conclusion: The 3D island sign in patients with intracerebral hemorrhage was a reliable predictor for early perihematomal edema expansion and poor functional outcome. It may serve as a potential therapeutic target for intervention.