{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T06:02:37Z","timestamp":1780293757453,"version":"3.54.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Patients with hypertensive intracerebral hemorrhage (ICH) are at risk for hematoma expansion (HE) in the early stages. Although the \u201cspot sign\u201d on computed tomography angiography (CTA) is a useful predictor of HE, the method has limitations, including low sensitivity and difficulty in identification. This study introduces a more recognizable and accessible \u201cbrush sign\u201d on plain CT images following CTA examination and compares its effectiveness with the \u201cspot sign\u201d in predicting HE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Hypertensive ICH patients admitted to the Advanced Stroke Center of the hospital from January 2023 to December 2024 were retrospectively analyzed. This study evaluated sequential plain CT neuroimaging after CTA in these patients, defined the \u201cbrush sign,\u201d and identified two morphological types, namely \u201cisolated\u201d and \u201ccontinuous.\u201d This study analyzed the correlations between the CTA \u201cspot sign,\u201d \u201cbrush sign,\u201d and other clinical data with HE. Finally, the HE prediction efficiency of the \u201cbrush sign\u201d and \u201cspot sign\u201d was compared using the receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 162 hypertensive ICH patients were enrolled, with 45 patients (27.8%) exhibiting HE. The spot, isolated brush, and continuous brush signs were observed in 48 (29.6%), 12 (7.4%), and 43 (26.5%) cases, respectively. The spot sign (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.017, OR\u202f=\u202f3.943, 95% CI [1.289\u201312.617]) and continuous brush sign (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016, OR\u202f=\u202f3.997, 95% CI [1.302\u201312.787]) were independent HE predictors. The ROC analysis showed that the continuous brush sign (AUC\u202f=\u202f0.895, specificity\u202f=\u202f0.949, sensitivity\u202f=\u202f0.862) and its combination with the spot sign (AUC\u202f=\u202f0.900, specificity\u202f=\u202f0.932, sensitivity\u202f=\u202f0.852) predicted HE with high accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The \u201cbrush sign\u201d can independently predict early HE in hypertensive ICH patients. The use of the continuous \u201cbrush sign\u201d either alone or in combination with the \u201cspot sign\u201d demonstrates high accuracy for predicting HE. These markers can be used to stratify HE risk and suggest early intervention strategies for hypertensive ICH patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1785855","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:27:25Z","timestamp":1780291645000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The \u201cbrush sign\u201d: a novel and accessible CT marker for hematoma expansion in hypertensive intracerebral hemorrhage"],"prefix":"10.3389","volume":"17","author":[{"given":"Jing","family":"Wang","sequence":"first","affiliation":[{"name":"Affiliated Yongchuan Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"Department of Neurology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuyue","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengli","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qisheng","family":"Cheng","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Ran","sequence":"additional","affiliation":[{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenjie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Xie","sequence":"additional","affiliation":[{"name":"Affiliated Yongchuan Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangwen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]},{"name":"Chongqing Key Laboratory of Cerebrovascular Diseases, Chongqing University Three Gorges Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.5853\/jos.2016.00864","article-title":"Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update","volume":"19","author":"An","year":"2017","journal-title":"J 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hemorrhage","volume":"4","author":"Delgado Almandoz","year":"2012","journal-title":"J Neurointerv Surg"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"3427","DOI":"10.1161\/STROKEAHA.112.664003","article-title":"Clinical applications of the computed tomography angiography spot sign in acute intracerebral hemorrhage: a review","volume":"43","author":"Brouwers","year":"2012","journal-title":"Stroke"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S1474-4422(12)70038-8","article-title":"Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study","volume":"11","author":"Demchuk","year":"2012","journal-title":"Lancet Neurol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2994","DOI":"10.1161\/STROKEAHA.109.554667","article-title":"Systematic characterization of the computed tomography angiography spot sign in primary 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