Satellite Sign: A Poor Outcome Predictor in Intracerebral Hemorrhage

Abstract

Background: The presence of high-density starry dots around the intracerebral hemorrhage (ICH), which we termed as a satellite sign, is occasionally observed in CT. The relationship between ICH with a satellite sign and its functional outcome has not been identified. This study aimed to determine whether the presence of a satellite sign could be an independent prognostic factor for patients with ICH. Methods: Patients with acute spontaneous ICH were retrospectively identified and their initial CT scans were reviewed. A satellite sign was defined as scattered high-density lesions completely separate from the main hemorrhage in at least the single axial slice. Functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge. Poor functional outcome was defined as mRS scores of 3-6. Univariate and multivariate logistic regression analyses were applied to assess the presence of a satellite sign and its association with poor functional outcome. Results: A total of 241 patients with ICH were enrolled in the study. Of these, 98 (40.7%) had a satellite sign. Patients with a satellite sign had a significantly higher rate of poor functional outcome (95.9%) than those without a satellite sign (55.9%, p < 0.0001). Multivariate logistic regression analysis revealed that higher age (OR 1.06; 95% CI 1.03-1.10; p = 0.00016), large hemorrhage size (OR 1.06; 95% CI 1.03-1.11; p = 0.00015), and ICH with a satellite sign (OR 13.5; 95% CI 4.42-53.4; p < 0.0001) were significantly related to poor outcome. A satellite sign was significantly related with higher systolic blood pressure (p = 0.0014), higher diastolic blood pressure (p = 0.0117), shorter activated partial thromboplastin time (p = 0.0427), higher rate of intraventricular bleeding (p < 0.0001), and larger main hemorrhage (p < 0.0001). Conclusions: The presence of a satellite sign in the initial CT scan is associated with a significantly worse functional outcome in ICH patients.

Prediction of Poor Outcome in Intracerebral Hemorrhage Based on Computed Tomography Markers

“…Island sign was referred to ≥3 scattered small hematomas, with complete hematoma separation; ≥4 scattered small hematomas partly or all connected with the main hematoma; round or oval scattered small hematomas separated from the main hematoma; foam or bud small hematomas connected with the main hematoma [10]. Satellite sign was at least one small hematoma separated from the main hematoma; the maximum transverse diameter of the small hematoma was <10 mm; the minimum distance between the small hematoma and the main hematoma was between 1 and 20 mm; subarachnoid hemorrhage and intraventricular hemorrhage were not included [11].…”

“…Non-contrast CT is the first choice of conventional examination in ICH because of its fastness and convenience. Recently, non-contrast CT markers, including hypodensities [6], hematoma density [7], blend sign [8], black hole sign [9], island sign [10], and satellite sign [11], are reported to be related with poor outcome in ICH. Therefore, we aim to develop a predictive model based on these markers in an ICH cohort and validate it in another cohort.…”

Blend Sign Is a Strong Predictor of the Extent of Early Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

“…However, CTA is not routinely used in many institutions (18). Recently, several NCCT markers have shown the ability to predict HE (19), such as the blend sign (BS) (20), black hole sign (BHS) (21), satellite sign (22), and island sign (23). Which imaging marker is better at predicting the EHE remains unclear.…”

Prognostic role of neutrophil lymphocyte ratio in patients with spontaneous intracerebral hemorrhage

“…Some biochemical parameters, such as cholesterol and ferritin level, were also reported to be biomarkers of outcomes [ 10 , 11 ]. Besides, it has been suggested that brain imaging parameters may predict outcome in ICH patients, for example, satellite sign and blend sign in the initial CT scan [ 12 , 13 ].…”