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

Rosa, Marcos; Rocha, Antônio José da; Saade, Nelson; Maia, Antônio Carlos Martins; Gagliardi, Rubens José

doi:10.1590/0004-282x20130124

Cited by 12 publications

(4 citation statements)

References 24 publications

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“…This is a retrospective study, and the case number with the spot sign only on dCTA after subgroup is relatively small, precluding a further multivariate assessment. Although CTA spot sign is a dynamic process, there are short and variable time intervals (median = 48–60 min) between the NCCT and dCTA in our study without the inclusion of 24-h follow-up CT as in previous studies conducted by other authors (9,10,16,24). As in other ROI-based studies, subjective freehand ROIs might have influenced the accuracy of the hematoma measurements.…”

Section: Discussionmentioning

confidence: 89%

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

Chen

Shiue

et al. 2017

Acta Radiol

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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.

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Section: Discussionmentioning

confidence: 89%

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

Chen

Shiue

et al. 2017

Acta Radiol

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“…Four articles were pertinent, including two articles of second-pass CTA [48] , [49] , and two studies of venous phase CTA [53] , [54] . Data of the second-pass CTA were combined together due to duplicate cohort.…”

Section: Resultsmentioning

confidence: 99%

The Accuracy of Spot Sign in Predicting Hematoma Expansion after Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Jiang

et al. 2014

PLoS ONE

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PurposeThe role of spot sign on computed tomography angiography (CTA) for predicting hematoma expansion (HE) after primary intracerebral hemorrhage (ICH) has been the focus of many studies. Our study sought to evaluate the predictive accuracy of spot signs for HE in a meta-analytic approach.Materials and MethodsThe database of Pubmed, Embase, and the Cochrane Library were searched for eligible studies. Researches were included if they reported data on HE in primary ICH patients, assessed by spot sign on first-pass CTA. Studies with additional data of second-pass CTA, post-contrast CT (PCCT) and CT perfusion (CTP) were also included.Results18 studies were pooled into the meta-analysis, including 14 studies of first-pass CTA, and 7 studies of combined CT modalities. In evaluating the accuracy of spot sign for predicting HE, studies of first-pass CTA showed that the sensitivity was 53% (95% CI, 49%–57%) with a specificity of 88% (95% CI, 86%–89%). The pooled positive likelihood ratio (PLR) was 4.70 (95% CI, 3.28–6.74) and the negative likelihood ratio (NLR) was 0.44 (95% CI, 0.34–0.58). For studies of combined CT modalities, the sensitivity was 73% (95% CI, 67%–79%) with a specificity of 88% (95% CI, 86%–90%). The aggregated PLR was 6.76 (95% CI, 3.70–12.34) and the overall NLR was 0.17 (95% CI 0.06–0.48).ConclusionsSpot signs appeared to be a reliable imaging biomarker for HE. The additional detection of delayed spot sign was helpful in improving the predictive accuracy of early spot signs. Awareness of our results may impact the primary ICH care by providing supportive evidence for the use of combined CT modalities in detecting spot signs.

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“…The spot sign in general yields a relatively high negative predictive value (NPV: 0.75–0.98) along with slightly lower positive predictive value (PPV: 0.45–1.00) toward hematoma expansion (Figure 4) (6, 16–24, 30). Sensitivity and specificity are reported to be 0.46–0.91 and 0.84–1.00, respectively (6, 16–24).…”

Section: Computed Tomography Angiographymentioning

confidence: 99%

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

et al. 2014

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Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.

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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

Cited by 12 publications

References 24 publications

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

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

The Accuracy of Spot Sign in Predicting Hematoma Expansion after Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

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