Background: Black hole sign represents a novel imaging marker for predicting hematoma
expansion (HE) in patients with intracerebral hemorrhage (ICH). Several previous studies
have reported the accuracy of black hole sign in predicting HE, but the accuracy was variable. We
performed a meta-analysis to systematically assess the accuracy of black hole sign in predicting
HE in patients with ICH.
Methods: A systematic search was performed to identify relevant English and Chinese articles
(from inception to January 2019). All studies on the accuracy of black hole sign in predicting HE
in patients with ICH were included. Pooled sensitivity, specificity, and positive and negative likelihood
ratios were calculated. Pooling was conducted using the bivariate generalized linear mixed
model. Forest plots and a summary receiver operator characteristic plot were generated. We used
I² to test heterogeneity and investigated the source of heterogeneity by meta-regression. Publication
bias was assessed by Deeks’ funnel plot asymmetry test.
Results: A total of 6 studies with 1876 patients were included in this meta-analysis. The pooled
sensitivity, specificity, and positive and negative likelihood ratios of black hole sign for predicting
HE were 0.30, 0.93, 4.00 and 0.75, respectively. The area under the curve (AUC) was 0.83. The
studies had substantial heterogeneity (I²=89.00%, 95% CI 78.00-100.00). Low risk of publication
bias was detected.
Conclusion: Black hole sign is a useful imaging marker with high specificity in predicting hematoma
expansion in patients with intracerebral hemorrhage.