Black hole sign (intracerebral haemorrhage)
Citation, DOI, disclosures and article data
Citation:
Alhusseiny K, Sharma R, Agazzi G, et al. Black hole sign (intracerebral haemorrhage). Reference article, Radiopaedia.org (Accessed on 24 Mar 2025) https://radiopaedia.org/articles/147425
DOI:
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rID:
147425
Article created:
Disclosures:
At the time the article was created Khalid Alhusseiny had no recorded disclosures.
View Khalid Alhusseiny's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.
View Rohit Sharma's current disclosures
Revisions:
7 times, by
6 contributors -
see full revision history and disclosures
Systems:
Sections:
Synonyms:
- CT black hole sign
The black hole sign refers to the non-contrast CT appearance of acute extravasation of blood into a haematoma, for example, an intracerebral haemorrhage, and therefore is a predictor of haemorrhage expansion 3. It can be thought of as an encapsulated swirl sign.
Radiographic features
The black hole sign represents a well-defined hypodense region within a hyperdense haematoma that is not connected to the nearby brain parenchyma 1,3. It may have a variable shape (e.g. round, oval, rod-like). There should be at least a 28 Hounsfield unit (HU) difference between the black hole and the surrounding haemorrhage 1,3.
Some data suggest this sign to be more specific in patients taking warfarin than direct oral anticoagulants (DOACs) 4.
References
- 1. Li Q, Zhang G, Xiong X et al. Black Hole Sign. Stroke. 2016;47(7):1777-81. doi:10.1161/strokeaha.116.013186
- 2. Shakya M, Fu F, Zhang M et al. Comparison of Black Hole Sign, Satellite Sign, and Iodine Sign to Predict Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage. BioMed Research International. 2021;2021:1-8. doi:https://doi.org/10.1155/2021/3919710
- 3. Morotti A, Boulouis G, Dowlatshahi D et al. Standards for Detecting, Interpreting, and Reporting Noncontrast Computed Tomographic Markers of Intracerebral Hemorrhage Expansion. Ann Neurol. 2019;86(4):480-92. doi:10.1002/ana.25563 - Pubmed
- 4. Sato H, Kinoshita M, Takano T et al. Black Hole Sign Under Anticoagulant Therapy: A Retrospective Comparison of Warfarin and Direct Oral Anticoagulants. AJNR Am J Neuroradiol. 2024;:ajnr.A8528. doi:10.3174/ajnr.a8528 - Pubmed
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