Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study

Demchuk, Andrew M.; Dowlatshahi, Dar; Rodríguez‐Luna, David; Molina, Carlos A.; Blas, Yolanda Silva; Dzialowski, Imanuel; Kobayashi, Adam; Boulanger, Jean-Martin; Lum, Cheemun; Gubitz, Gord; Padma, Vasantha; Roy, Jayanta; Kase, Carlos S.; Kosior, Jayme C.; Bhatia, Rohit; Tymchuk, Sarah; Subramaniam, Suresh; Gladstone, David J.; Hill, Michael D.; Aviv, Richard I.

doi:10.1016/s1474-4422(12)70038-8

Cited by 533 publications

(464 citation statements)

References 30 publications

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“…Our data are consistent with previously published results, confirming similar results in the detection of spot sign within ICH and reinforcing the applicability of CTA to clarify the risk of a worse prognosis, including in-hospital morta lity 3,4,16 . The demographic data among our patients were similar to those in previous studies 1,4 .…”

Section: Discussionsupporting

confidence: 92%

“…The detection of a spot sign in our series of patients was less frequent than in certain previous reported series 2,22,23,25,27 , most likely due to their shorter delay before arriving at the hospital. Spot sign detection is higher if the CTA is obtained within the first 3 hours after stroke 2,27 , but it has also been documented after this period and can be detected during both phases of MDCT angiography (arterial and venous) 3,4 . The reported frequency of these delayed spot signs, which are detected during the venous phase of MDCT angiography, ranges from 8% to 23% of all the spot signs identified in various series 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The presence and characteristics of an active extravasation of contrast within the ICH (spot sign) was initially detected on angiography as a predictor of hemorrhage expansion 5 . This imaging sign has also been reproduced on MDCT angiography as a robust predictor of expansion and as an indicator of worse prognosis and mortality 3,4 . MDCT angiography has been proven to be a rapid and reproducible alternative to catheter angiography that reduces the risks to the enrolled patients and offers significant benefits to the decision-making process [6][7][8][9] .…”

mentioning

confidence: 84%

“…Hematoma expansion was defined at the followup NCCT by an absolute growth greater than 6 ml or a relative growth of more than 33% from the initial NCCT 3 . A poor outcome was defined as substantial hematoma expansion at followup CT, death, or the need for surgery.…”

Section: Imaging Analysismentioning

confidence: 99%

“…Recent studies have confirmed that expanding hematoma occurs in approximately 70% of patients undergoing CT scan within the first 3 hours of stroke, suggesting that certain findings on MDCT angiography are likely predictors of growth hemorrhage 3,4 . The most important predictor of mortality and neurological disability is the initial volume of the ICH; however, hematoma expansion leads to a conservative prognosis.…”

mentioning

confidence: 99%

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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

Rosa

Rocha

Saade

et al. 2013

Arq. Neuro-Psiquiatr.

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Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 84%

Section: Imaging Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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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

Rosa

Rocha

Saade

et al. 2013

Arq. Neuro-Psiquiatr.

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Anticoagulant Reversal, Blood Pressure Levels, and Anticoagulant Resumption in Patients With Anticoagulation-Related Intracerebral Hemorrhage

Kuramatsu

Gerner

Schellinger

et al. 2015

JAMA

459

374

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Cerebral Intraparenchymal Hemorrhage

Gross

Jankowitz

Friedlander

2019

JAMA

216

159

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pontaneous intraparenchymal hemorrhage (IPH) is relatively common and has devastating consequences. Recognition of risk factors (eg, hypertension), early distinction from an ischemic event, and identification of clinical features that can worsen IPH complications is important in optimizing outcomes from IPH. This review examines the pathophysiology of and management options for IPH, with the intent of helping clinicians better manage the condition. IPH accounts for 6.5% to 19.6% of cases of stroke 1,2 but is associated with the greatest rate of mortality; 1-year survival from IPH is approximately 40%, 3-5 and 10-year survival is 24%. 4 Across several studies, the rate of functional independence at follow-up varied from 12% to 39%. 5 A meta-analysis of 36 studies reported an incidence of IPH of 24.6 per 100 000 person-years (range, 1.8-129.6), and the rate was significantly higher in Asian and older populations. 5 MethodsThe PubMed database was searched on September 1, 2018, using the terms intracerebral hemorrhage and intraparenchymal hemorrhage, for English-language studies of the pathophysiology, epidemiology, and management of IPH published after January 1, 2015. Large population epidemiologic studies, randomized trials, and formal treatment guidelines were reviewed. Relevant references published before January 1, 2015, were extracted and also reviewed. Studies providing only aggregate data for all types of hemorrhagic stroke (including subarachnoid hemorrhage) were excluded. This review was based on 77 referenced articles, including 11 clinical trials, 10 meta-analyses, 41 observational studies, 2 guidelines, and 13 other reports.

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Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study

Cited by 533 publications

References 30 publications

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

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

Anticoagulant Reversal, Blood Pressure Levels, and Anticoagulant Resumption in Patients With Anticoagulation-Related Intracerebral Hemorrhage

Cerebral Intraparenchymal Hemorrhage

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