Black Hole Sign

David Goldemund M.D.
Updated on 20/12/2023, published on 25/02/2022
  • the black hole sign (BHS) is a non-contrast CT scan marker of increased risk of early hematoma growth and a predictor of poor outcome in patients with intracerebral hemorrhage (Zhang, 2016)
    • BHS  is more common in patients with hematoma growth (31.9%) than those with no hematoma progression (5.8%) [Li, 2016]
  • it correlates well with spot sign, which seems to be more reliable and sensitive [Sporns, 2017]
Black hole sign on NCCT
Black hole sign on NCCT

Definition of Black Hole Sign [Li, 2016]
  • relatively hypoattenuating area (black hole) encapsulated within the hematoma (difference > 28 HU)
  • round, oval, or rod-like in shape
  • not connected with the adjacent brain tissue
  • the area should have a well-identifiable border

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Black Hole Sign