• Fan Zhang, Hao Li, Juan Qian, Si Zhang, Chuanyan Tao, Chao You, and Mu Yang.
• Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
• World Neurosurg. 2018 Dec 1; 120: e304-e312.

BackgroundThe island sign is a novel imaging predictor for early hematoma growth, implying multifocal active bleeding. The prognostic value of the island sign for long-term outcome in patients with intracranial hemorrhage (ICH) remains unrevealed. The aim of this study is to investigate associations between the island land and long-term prognosis in patients with ICH.MethodsBoth clinical characteristics and radiologic parameters were retrospectively obtained from electronic medical records. According to the initial and follow-up computed tomography scans of patients, hematoma expansion and the island sign were determined independently with 2 experienced physicians. Multivariate logistic regression analyses were used to explore the associations of hematoma expansion, 1-year poor outcome, and 1-year death on other clinical variables.ResultsA total of 322 patients were included, and 126 of them presented with early hematoma expansion, with 81 exhibiting the island sign. There were 116 patients who died, and 157 patients with ICH had poor outcome at the first year after onset. The multivariate logistic regression analyses revealed that initial Glasgow Coma Scale score, hematoma size, and presence of intraventricular hemorrhage and island sign were strongly associated with long-term poor outcomes.ConclusionsThe island sign is an easy-to-use and novel imaging marker which predicts both early hematoma expansion and long-term poor prognosis.Copyright © 2018 Elsevier Inc. All rights reserved.

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