Leakage Sign for Primary Intracerebral Hemorrhage

Orito, Kensuke; Hirohata, Masaru; Nakamura, Yukihiko; Takeshige, Nobuyuki; Aoki, Takeshi; Hattori, Gousuke; Sakata, Kiyohiko; Abe, Toshi; Uchiyama, Yuusuke; Sakamoto, Teruo; Morioka, Motohiro

doi:10.1161/strokeaha.115.011578

Cited by 74 publications

(43 citation statements)

References 20 publications

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“…The leakage sign-positive group was ranked as severe according to the GCS score on admission (Table 1). Previous reports have shown that in leakage sign-positive cases, hematoma expansion occurs in intracerebral hemorrhage [9] and contusional hematoma [10]. Many previous studies have attempted to develop methods for the prediction of hematoma expansion in patients with intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…The leakage sign method has been previously documented [9, 10]. CT acquisitions were performed according to standard departmental protocols using eight-section General Electric helical CT scanners (BrightSpeed Edge, GE Healthcare, Wisconsin, USA).…”

Section: Methodsmentioning

confidence: 99%

“…1). Plain CT was performed 24 h after the first CT to evaluate the hematoma size and other intracranial findings; a detailed method has been described previously [9].

Fig.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously reported a sensitive predictive method named “leakage sign” for contusional hematoma cases, with high sensitivity, specificity, and predictive value for hematoma expansion [9]. The purpose of this study was to establish a sensitive predictive method for ASDH expansion using this leakage sign.…”

Section: Introductionmentioning

confidence: 99%

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Leakage sign for acute subdural hematoma in clinical treatment

et al. 2018

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Background Acute subdural hematoma (ASDH) is a serious traumatic disease, and predictive methods for hematoma growth are necessary to decide whether emergent operation is necessary. This study aimed to evaluate the incidence of “leakage” using computed tomography angiography (CTA) in patients with ASDH and to identify its prognostic value. Methods Sixty-seven patients with ASDH were examined using CTA (mean age 64.1 ± 20.6 years; 24 men) by analyzing two serial scans (CTA phase and delayed phase). We defined a positive leakage sign as a > 10% increase in Hounsfield units (HU) in the region of interest. Hematoma expansion was determined using plain CT after 24 h in patients who did not undergo emergent surgery. Results Of the 67 patients, conservative therapy was administered to 35 patients; of these patients, 9 showed hematoma expansion, and 8 of these 9 patients (88.9%) showed positive leakage signs. The sensitivity and specificity of leakage signs to hematoma expansion in the no-surgery group were 88.8% and 76.1%, respectively. All positive leakage signs were found within 4.5 h of injury; patients showing negative leakage signs showed a decreased tendency towards hematoma 24 h after injury. Patients presenting with positive leakage signs had poor outcomes. Conclusions The results indicated that the leakage sign is a sensitive predictor of hematoma expansion and poor outcomes in ASDH. If the hematoma is small but leakage sign-positive, strict observation is necessary and aggressive surgery may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…1). Plain CT was performed 24 h after the first CT to evaluate the hematoma size and other intracranial findings; a detailed method has been described previously [9].

Fig.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leakage sign for acute subdural hematoma in clinical treatment

et al. 2018

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“…This technique may also improve spot sign detection and prediction of intraoperative aneurysm rupture in patients with acute subarachnoid hemorrhage [5, 6]. In addition, the “leakage sign” has been recently described as a promising imaging marker of ICH expansion [23] and the calibration procedure may improve the diagnostic performance of this CTA based marker as well.…”

Section: Discussionmentioning

confidence: 99%

Phantom-based standardization of CT angiography images for spot sign detection

et al. 2017

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Purpose The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance. Methods A custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield Unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%. Results A total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8% vs 38.9% p<0.001). All spot signs identified in the non-calibrated analysis remained positive after calibration. Calibrated CTA images had higher sensitivity for ICH expansion (76% vs 52%) but inferior specificity (35% vs 63%) compared with uncalibrated images. Conclusion Normalization of CTA images using phantom data is a feasible strategy to obtain consistent image quantification for spot sign analysis across different sites and may improve sensitivity for identification of ICH expansion.

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Recognizing and Preventing Intracerebral Hematoma Expansion

Caplan

2016

JAMA Neurol

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Leakage Sign for Primary Intracerebral Hemorrhage

Abstract: Supplemental Digital Content is available in the text.

Cited by 74 publications

References 20 publications

Leakage sign for acute subdural hematoma in clinical treatment

Leakage sign for acute subdural hematoma in clinical treatment

Phantom-based standardization of CT angiography images for spot sign detection

Recognizing and Preventing Intracerebral Hematoma Expansion

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