Black hole sign (intracerebral hemorrhage)
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At the time the article was created Khalid Alhusseiny had no recorded disclosures.View Khalid Alhusseiny's current disclosures
At the time the article was last revised Frank Gaillard had the following disclosures:
- Radiopaedia Australia Pty Ltd and Radiopaedia Events Pty Ltd, Director, Founder and CEO (Radiopaedia) (ongoing)
- Biogen Australia Pty Ltd, Investigator-Initiated Research Grant for CAD software in multiple sclerosis: finished Oct 2021 (past)
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The black hole sign refers to the non-contrast CT appearance of acute extravasation of blood into a hematoma, for example, an intracerebral hemorrhage, and therefore is a predictor of hemorrhage expansion 3. It can be thought of as an encapsulated swirl sign.
The black hole sign represents a well-defined hypodense region within a hyperdense hematoma that is not connected to the nearby brain parenchyma 1,3. It may have variable shapes (round, oval, rod-like).
There should be at least a 28 Hounsfield unit (HU) difference between the black hole and the surrounding hemorrhage 1,3.
- 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