Blend sign

David Goldemund M.D.
Updated on 05/11/2023, published on 25/02/2022

  • early hematoma growth is observed in approximately one-third of the patients with spontaneous intracerebral hemorrhage (ICH)
  • the blend sign (BS) on baseline non-contrast computed tomography (NCCT) is a marker of increased risk of hemorrhage progression and a predictor of poor outcome in patients with ICH  Blend sign predicts poor prognosis in ICH patients (Li, 2017)   [Li, 2017]
    • blend sign is not associated with poor outcomes in patients with hypertensive ICH after stereotactic minimally invasive surgery (sMIS)  (Yang, 2021)
  • the BS has a good correlation with the spot sign, the latter being more sensitive and reliable but requiring the administration of a contrast agent  [Sporns, 2017]
  • blend sign and black hole sign can help predict outcome when CT angiography is unavailable
Blend sign specifications
  • a mix of hyperdense and relatively hypodense areas (difference > 18 HU)
  • easily distinguishable by eye
  • sharply demarcated from each other
  • the hypodense area is not completely surrounded by the hyperdense area
Blend sign - a mix of hyperdense and relatively hypodense areas (difference > 18 HU) easily distinguishable by eye
Blend sign
Blend sign (baseline and 3hr later)

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Blend Sign
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