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CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage
Morbidity and mortality in spontaneous intracerebral hemorrhage (ICH) are correlated with hematoma progression. We hypothesized that the presence of tiny, enhancing foci ("spot sign") within acute hematomas is associated with hematoma expansion. We prospectively studied 39 consecutive pati...
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| Published in: | Stroke (1970) 2007-04, Vol.38 (4), p.1257-1262 |
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| container_title | Stroke (1970) |
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| creator | WADA, Ryan AVIV, Richard I FOX, Allan J SAHLAS, Demetrios J GLADSTONE, David J TOMLINSON, George SYMONS, Sean P |
| description | Morbidity and mortality in spontaneous intracerebral hemorrhage (ICH) are correlated with hematoma progression. We hypothesized that the presence of tiny, enhancing foci ("spot sign") within acute hematomas is associated with hematoma expansion.
We prospectively studied 39 consecutive patients with spontaneous ICH by computed tomography angiography within 3 hours of symptom onset. Scans were reviewed by 3 readers. Patients were dichotomized according to the presence or absence of the spot sign. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in a multivariate analysis.
Thirteen patients (33%) demonstrated 31 enhancing foci. Baseline clinical variables were similar in both groups. Hematoma expansion occurred in 11 patients (28%) on follow-up. Seventy-seven percent of patients with and 4% without hematoma expansion demonstrated the spot sign (P |
| doi_str_mv | 10.1161/01.STR.0000259633.59404.f3 |
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We prospectively studied 39 consecutive patients with spontaneous ICH by computed tomography angiography within 3 hours of symptom onset. Scans were reviewed by 3 readers. Patients were dichotomized according to the presence or absence of the spot sign. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in a multivariate analysis.
Thirteen patients (33%) demonstrated 31 enhancing foci. Baseline clinical variables were similar in both groups. Hematoma expansion occurred in 11 patients (28%) on follow-up. Seventy-seven percent of patients with and 4% without hematoma expansion demonstrated the spot sign (P<0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for expansion were 91%, 89%, 77%, 96%, and 8.5, respectively. Interobserver agreement was high (kappa=0.92 to 0.94). In patients with the spot sign, mean volume change was greater (P=0.008), extravasation more common (P=0.0005), and median hospital stay longer (P=0.04), and fewer patients achieved a good outcome (modified Rankin Scale score <2), although the latter was not significant (P=0.16). No differences in hydrocephalus (P=1.00), surgical intervention (P=1.00), or death (P=0.60) were noted between groups. In multiple regression, the spot sign independently predicted hematoma expansion (P=0.0003).
The computed tomography angiography spot sign is associated with the presence and extent of hematoma progression. Fewer patients achieve a good clinical outcome and hospital stay was longer. Further studies are warranted to validate the ability of this sign to predict clinical outcomes.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000259633.59404.f3</identifier><identifier>PMID: 17322083</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Brain - diagnostic imaging ; Brain - pathology ; Brain - physiopathology ; Cardiovascular system ; Cerebral Angiography - methods ; Cerebral Angiography - statistics & numerical data ; Cerebral Arteries - diagnostic imaging ; Cerebral Arteries - pathology ; Cerebral Arteries - physiopathology ; Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - pathology ; Cerebral Hemorrhage - physiopathology ; Disease Progression ; Female ; Hematoma - diagnostic imaging ; Hematoma - pathology ; Hematoma - physiopathology ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Nervous system ; Neurology ; Observer Variation ; Predictive Value of Tests ; Prognosis ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Tomography, X-Ray Computed - methods ; Tomography, X-Ray Computed - statistics & numerical data ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2007-04, Vol.38 (4), p.1257-1262</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c558t-3024586ca8f4300d734ba5054d3dff25ef4d8ce02d0d4b4f2a66ea3876b091093</citedby><cites>FETCH-LOGICAL-c558t-3024586ca8f4300d734ba5054d3dff25ef4d8ce02d0d4b4f2a66ea3876b091093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18639039$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17322083$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WADA, Ryan</creatorcontrib><creatorcontrib>AVIV, Richard I</creatorcontrib><creatorcontrib>FOX, Allan J</creatorcontrib><creatorcontrib>SAHLAS, Demetrios J</creatorcontrib><creatorcontrib>GLADSTONE, David J</creatorcontrib><creatorcontrib>TOMLINSON, George</creatorcontrib><creatorcontrib>SYMONS, Sean P</creatorcontrib><title>CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Morbidity and mortality in spontaneous intracerebral hemorrhage (ICH) are correlated with hematoma progression. We hypothesized that the presence of tiny, enhancing foci ("spot sign") within acute hematomas is associated with hematoma expansion.
We prospectively studied 39 consecutive patients with spontaneous ICH by computed tomography angiography within 3 hours of symptom onset. Scans were reviewed by 3 readers. Patients were dichotomized according to the presence or absence of the spot sign. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in a multivariate analysis.
Thirteen patients (33%) demonstrated 31 enhancing foci. Baseline clinical variables were similar in both groups. Hematoma expansion occurred in 11 patients (28%) on follow-up. Seventy-seven percent of patients with and 4% without hematoma expansion demonstrated the spot sign (P<0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for expansion were 91%, 89%, 77%, 96%, and 8.5, respectively. Interobserver agreement was high (kappa=0.92 to 0.94). In patients with the spot sign, mean volume change was greater (P=0.008), extravasation more common (P=0.0005), and median hospital stay longer (P=0.04), and fewer patients achieved a good outcome (modified Rankin Scale score <2), although the latter was not significant (P=0.16). No differences in hydrocephalus (P=1.00), surgical intervention (P=1.00), or death (P=0.60) were noted between groups. In multiple regression, the spot sign independently predicted hematoma expansion (P=0.0003).
The computed tomography angiography spot sign is associated with the presence and extent of hematoma progression. Fewer patients achieve a good clinical outcome and hospital stay was longer. Further studies are warranted to validate the ability of this sign to predict clinical outcomes.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Brain - diagnostic imaging</subject><subject>Brain - pathology</subject><subject>Brain - physiopathology</subject><subject>Cardiovascular system</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebral Angiography - statistics & numerical data</subject><subject>Cerebral Arteries - diagnostic imaging</subject><subject>Cerebral Arteries - pathology</subject><subject>Cerebral Arteries - physiopathology</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - pathology</subject><subject>Cerebral Hemorrhage - physiopathology</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Hematoma - diagnostic imaging</subject><subject>Hematoma - pathology</subject><subject>Hematoma - physiopathology</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Observer Variation</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Tomography, X-Ray Computed - statistics & numerical data</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNpFkU1r4zAQhsXSZZu2-xeKKbQ3e0cayZF7K6FfUCh0s3sVY1lKXPxVyYHm39dpApnLzOF5Z-AZxq44ZJzn_A_w7O_yLYOphCpyxEwVEmTm8QebcSVkKnOhT9gMAItUyKI4ZWcxvu941OoXO-VzFAI0ztj_xTKhblX3q0DDepvEoR-TWK-6ZAiuqu0Yk7VraexbStznQF2s-y6pu4TsZnTTMAayLrgyULMj-xDWtHIX7KenJrrfh37O_j3cLxdP6cvr4_Pi7iW1SukxRRBS6dyS9hIBqjnKkhQoWWHlvVDOy0pbB6KCSpbSC8pzR6jneQkFhwLP2c1-7xD6j42Lo2nraF3TUOf6TTRzQC6Fxgm83YM29DEG580Q6pbC1nAwO6sGuJmsmqNV823V-F348nBlU7auOkYPGifg-gBQtNT4QJ2t45HTORbTL_ALcYCBhA</recordid><startdate>20070401</startdate><enddate>20070401</enddate><creator>WADA, Ryan</creator><creator>AVIV, Richard I</creator><creator>FOX, Allan J</creator><creator>SAHLAS, Demetrios J</creator><creator>GLADSTONE, David J</creator><creator>TOMLINSON, George</creator><creator>SYMONS, Sean P</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070401</creationdate><title>CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage</title><author>WADA, Ryan ; AVIV, Richard I ; FOX, Allan J ; SAHLAS, Demetrios J ; GLADSTONE, David J ; TOMLINSON, George ; SYMONS, Sean P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c558t-3024586ca8f4300d734ba5054d3dff25ef4d8ce02d0d4b4f2a66ea3876b091093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Brain - diagnostic imaging</topic><topic>Brain - pathology</topic><topic>Brain - physiopathology</topic><topic>Cardiovascular system</topic><topic>Cerebral Angiography - methods</topic><topic>Cerebral Angiography - statistics & numerical data</topic><topic>Cerebral Arteries - diagnostic imaging</topic><topic>Cerebral Arteries - pathology</topic><topic>Cerebral Arteries - physiopathology</topic><topic>Cerebral Hemorrhage - diagnostic imaging</topic><topic>Cerebral Hemorrhage - pathology</topic><topic>Cerebral Hemorrhage - physiopathology</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Hematoma - diagnostic imaging</topic><topic>Hematoma - pathology</topic><topic>Hematoma - physiopathology</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Observer Variation</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Tomography, X-Ray Computed - statistics & numerical data</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WADA, Ryan</creatorcontrib><creatorcontrib>AVIV, Richard I</creatorcontrib><creatorcontrib>FOX, Allan J</creatorcontrib><creatorcontrib>SAHLAS, Demetrios J</creatorcontrib><creatorcontrib>GLADSTONE, David J</creatorcontrib><creatorcontrib>TOMLINSON, George</creatorcontrib><creatorcontrib>SYMONS, Sean P</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WADA, Ryan</au><au>AVIV, Richard I</au><au>FOX, Allan J</au><au>SAHLAS, Demetrios J</au><au>GLADSTONE, David J</au><au>TOMLINSON, George</au><au>SYMONS, Sean P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2007-04-01</date><risdate>2007</risdate><volume>38</volume><issue>4</issue><spage>1257</spage><epage>1262</epage><pages>1257-1262</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Morbidity and mortality in spontaneous intracerebral hemorrhage (ICH) are correlated with hematoma progression. We hypothesized that the presence of tiny, enhancing foci ("spot sign") within acute hematomas is associated with hematoma expansion.
We prospectively studied 39 consecutive patients with spontaneous ICH by computed tomography angiography within 3 hours of symptom onset. Scans were reviewed by 3 readers. Patients were dichotomized according to the presence or absence of the spot sign. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in a multivariate analysis.
Thirteen patients (33%) demonstrated 31 enhancing foci. Baseline clinical variables were similar in both groups. Hematoma expansion occurred in 11 patients (28%) on follow-up. Seventy-seven percent of patients with and 4% without hematoma expansion demonstrated the spot sign (P<0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for expansion were 91%, 89%, 77%, 96%, and 8.5, respectively. Interobserver agreement was high (kappa=0.92 to 0.94). In patients with the spot sign, mean volume change was greater (P=0.008), extravasation more common (P=0.0005), and median hospital stay longer (P=0.04), and fewer patients achieved a good outcome (modified Rankin Scale score <2), although the latter was not significant (P=0.16). No differences in hydrocephalus (P=1.00), surgical intervention (P=1.00), or death (P=0.60) were noted between groups. In multiple regression, the spot sign independently predicted hematoma expansion (P=0.0003).
The computed tomography angiography spot sign is associated with the presence and extent of hematoma progression. Fewer patients achieve a good clinical outcome and hospital stay was longer. Further studies are warranted to validate the ability of this sign to predict clinical outcomes.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>17322083</pmid><doi>10.1161/01.STR.0000259633.59404.f3</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Aged Aged, 80 and over Biological and medical sciences Brain - diagnostic imaging Brain - pathology Brain - physiopathology Cardiovascular system Cerebral Angiography - methods Cerebral Angiography - statistics & numerical data Cerebral Arteries - diagnostic imaging Cerebral Arteries - pathology Cerebral Arteries - physiopathology Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - pathology Cerebral Hemorrhage - physiopathology Disease Progression Female Hematoma - diagnostic imaging Hematoma - pathology Hematoma - physiopathology Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Multivariate Analysis Nervous system Neurology Observer Variation Predictive Value of Tests Prognosis Radiodiagnosis. Nmr imagery. Nmr spectrometry Tomography, X-Ray Computed - methods Tomography, X-Ray Computed - statistics & numerical data Vascular diseases and vascular malformations of the nervous system |
| title | CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage |
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