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Abstract

Background

The computed tomography angiography (CTA) spot sign represents active contrast extravasation within acute primary intracerebral hemorrhage (ICH) and is an independent predictor of hematoma expansion (HE) and poor clinical outcomes. The spot sign could be detected on first-pass CTA (fpCTA) or delayed CTA (dCTA).

Purpose

To investigate the additional benefits of dCTA spot sign in primary ICH and hematoma size for predicting spot sign.

Material and Methods

This is a retrospective study of 100 patients who underwent non-contrast CT (NCCT) and CTA within 24 h of onset of primary ICH. The presence of spot sign on fpCTA or dCTA, and hematoma size on NCCT were recorded. The spot sign on fpCTA or dCTA for predicting significant HE, in-hospital mortality, and poor clinical outcomes (mRS ≥ 4) are calculated. The hematoma size for prediction of CTA spot sign was also analyzed.

Results

Only the spot sign on dCTA could predict high risk of significant HE and poor clinical outcomes as on fpCTA (P < 0.05). With dCTA, there is increased sensitivity and negative predictive value (NPV) for predicting significant HE, in-hospital mortality, and poor clinical outcomes. The XY value (product of the two maximum perpendicular axial dimensions) is the best predictor (area under the curve [AUC] = 0.82) for predicting spot sign on fpCTA or dCTA in the absence of intraventricular and subarachnoid hemorrhage.

Conclusion

This study clarifies that dCTA imaging could improve predictive performance of CTA in primary ICH. Furthermore, the XY value is the best predictor for CTA spot sign.

Keywords

Computed tomography angiography CTA spot sign intracranial hematoma ICH

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References

Qureshi

Tuhrim

Broderick

et al.

Spontaneous intracerebral hemorrhage. N Engl J Med 2001; 344: 1450–1460.

van Asch

Luitse

Rinkel

et al.

Incidence, case fatality, and functional outcomes of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9: 167–176.

Davis

Broderick

Hennerici

et al.

Hematoma growth is a determinant of mortality and poor outcomes after intracerebral hemorrhage. Neurology 2006; 66: 1175–1181.

Becker

Baxter

Bybee

et al.

Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage. Stroke 1999; 30: 2025–2032.

Demchuk

Dowlatshahi

Rodriguez-Luna

et al.

Prediction of haematoma growth and outcomes in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol 2012; 11: 307–314.

Khosravani

Mayer

Demchuk

et al.

Emergency noninvasive angiography for acute intracerebral hemorrhage. Am J Neuroradiol 2013; 34: 1481–1487.

Wada

Aviv

Fox

et al.

CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 2007; 38: 1257–1262.

Kim

Smith

Hemphill

3rd et al.

Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. Am J Neuroradiol 2008; 29: 520–525.

Delgado Almandoz

Yoo

Stone

et al.

Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score. Stroke 2009; 40: 2994–3000.

10.

Delgado Almandoz

Yoo

Stone

et al.

The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcomes among survivors. Stroke 2010; 41: 54–60.

11.

Chakraborty

Blacquiere

Lum

et al.

Dynamic nature of the CT angiographic “spot sign”. Br J Radiol 2010; 83: 216–219.

12.

Hallevi

Abraham

Barreto

et al.

The spot sign in intracerebral hemorrhage: the importance of looking for contrast extravasation. Cerebrovasc Dis 2010; 29: 217–220.

13.

Koculym

Huynh

Jakubovic

et al.

CT perfusion spot sign improves sensitivity for prediction of outcomes compared with CTA and postcontrast CT. Am J Neuroradiol 2013; 34: 965–970.

14.

Sun

Gao

Sui

et al.

“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage. Eur Radiol 2013; 23: 1846–1854.

15.

Ciura

Brouwers

Pizzolato

et al.

Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study. Stroke 2014; 45: 3293–3297.

16.

Rodriguez-Luna

Dowlatshahi

Aviv

et al.

Venous phase of computed tomography angiography increases spot sign detection, but intracerebral hemorrhage expansion is greater in spot signs detected in arterial phase. Stroke 2014; 45: 734–739.

17.

Jiang

et al.

The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage: a systematic review and meta-analysis. PLoS One 2014; 9: e115777–e115777.

18.

van Swieten

Koudstaal

Visser

et al.

Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604–607.

19.

Landis

Koch

. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

20.

Brouwers

Battey

Musial

et al.

Rate of contrast extravasation on computed tomographic angiography predicts hematoma expansion and mortality in primary intracerebral hemorrhage. Stroke 2015; 46: 2498–2503.

21.

Ederies

Demchuk

Chia

et al.

Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke 2009; 40: 1672–1676.

22.

Hemphill

3rd Greenberg

Anderson

et al.

Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46: 2032–2060.

23.

Hemphill

3rd Bonovich

Besmertis

et al.

The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32: 891–897.

24.

Rosa Junior

Rocha

Saade

et al.

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage. Arq Neuropsiquiatr 2013; 71: 791–797.

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Added value of delayed computed tomography angiography in primary intracranial hemorrhage and hematoma size for predicting spot sign

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References

Supplementary Material