Risk for Intracerebral Hematoma Expansion—More Than Just the Spot Sign

2016 ◽  
Vol 73 (12) ◽  
pp. 1401 ◽  
Author(s):  
Eric E. Smith
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

Prevalence and diagnostic performance of computed tomography angiography spot sign for intracerebral hematoma expansion depend on scan timing

2014 ◽  
Vol 56 (12) ◽  
pp. 1039-1045 ◽  
Author(s):  
Akio Tsukabe ◽  
Yoshiyuki Watanabe ◽  
Hisashi Tanaka ◽  
Yuki Kunitomi ◽  
Mitsuo Nishizawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

Spot sign and live-imaged dramatic intracerebral hematoma expansion

Neurology ◽  
2011 ◽  
Vol 76 (14) ◽  
pp. 1275-1276
Author(s):  
M. A. Almekhlafi ◽  
J. C. Kosior ◽  
D. Dowlatshahi ◽  
A. M. Demchuk ◽  
P. G. Bermejo ◽  
...  
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

scholarly journals From Spot Sign to Bleeding on the Spot: Classic and Original Signs of Expanding Primary Spontaneous Intracerebral Hematoma

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ali Kanj ◽  
Abir Ayoub ◽  
Malak Aljoubaie ◽  
Ahmad Kanj ◽  
Assaad Mohanna ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Medical Center ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Magnetic Resonance Study ◽  
Spot Sign ◽  
Early Predictors ◽  
Drastic Increase ◽  
Spontaneous Intracranial Hemorrhage ◽  
Mri Study

Expansion of a primary spontaneous intracranial hemorrhage (PSICH) has become lately of increasing interest, especially after the emergence of its early predictors. However, these signs lacked sensitivity and specificity. The flood phenomenon, defined as a drastic increase in the size of a PSICH during the same magnetic resonance study, was first described in this paper based on the data of a university medical center in Lebanon. Moreover, further review of this data resulted in 205 studies with presumed diagnosis of primary spontaneous intracranial hemorrhage within the last 10 years, of which 29 exams showed typical predictors of hematoma expansion on computed tomography. The intended benefit of this observation is to draw the radiologists’ attention towards minimal variations in the volume of the hematoma between the two extreme sequences of the same MRI study, in order to detect inconspicuous flood phenomena—a direct sign of hematoma expansion.

Abstract WMP83: Prediction of Intracerebral Hematoma Expansion: Multicenter External Validation of the CTA Spot Sign Score

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Thien J Huynh ◽  
Andrew Demchuk ◽  
Dar Dowlatshahi ◽  
Ölem Krischek ◽  
Alex Kiss ◽  
...  
Keyword(s):  
External Validation ◽  
Area Under The Curve ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign ◽  
Perfect Agreement ◽  
Sagittal Sinus ◽  
Spot Number ◽  
Hematoma Growth ◽  
Contrast Ct

Background and Purpose: The spot sign score (SSS) stratifies hematoma expansion risk in patients with acute intracerebral hemorrhage (ICH) but is not externally validated. We sought to validate the SSS and assess prognostic spot characteristics associated with hematoma expansion in a prospective multicenter study. Methods: We studied 228 ICH patients presenting < 6 hours post-onset enrolled in the PREDICT (PREdicting hematoma growth anD outcome in ICH using contrast bolus CT) study, a multicentre prospective observational cohort study of ICH patients evaluated with baseline non-contrast CT, CT angiography (CTA), and 24-hour follow-up CT. Primary outcome was significant hematoma expansion (>6ml or >33%). Secondary outcomes were absolute and relative expansion. Blinded CTA spot sign characterization (spot number, maximum axial size and attenuation, and relative attenuation compared to the ipsilateral internal carotid artery and superior sagittal sinus) and SSS calculation was performed independently by two neuroradiologists and a radiology resident. Multivariable regression for prediction of hematoma expansion was performed and diagnostic performance of the SSS and spot characteristics was examined with ROC analysis and tests for trend. Results: SSS independently predicted significant, absolute, and relative hematoma expansion (p-values of 0.001, <0.001, and 0.009, respectively), adjusting for initial hematoma volume, INR, mean arterial pressure, and time from onset-to-baseline CT, and demonstrated near perfect interobserver agreement (κ = 0.82). Spot number and SSS demonstrated similar area under the curve (AUC 0.69 vs. 0.68, p=0.149) for hematoma expansion. Incremental risk of hematoma expansion was demonstrated with increasing SSS however a significant trend was not identified (p trend=0.720). Of all spot characteristics, only spot number was independently associated with expansion (p<0.001) providing incremental risk stratification (p trend=0.050) and near perfect agreement (κ=0.85). Median absolute hematoma growth for 0, 1, 2 to 3, ≥4 spots was 0.4, 4, 12, 82 ml respectively. Conclusion: Spot number is the single best predictor of significant ICH expansion and appears to be as good as the total SSS in predicting expansion.

scholarly journals Spot sign and live-imaged dramatic intracerebral hematoma expansion

Neurology ◽  
2010 ◽  
Vol 75 (9) ◽  
pp. 834-834 ◽  
Author(s):  
P. G. Bermejo ◽  
J. A. Garcia ◽  
S. Perez-Fernandez ◽  
J. F. Arenillas
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

Stroke ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 350-355 ◽  
Author(s):  
David Rodriguez-Luna ◽  
Teri Stewart ◽  
Dar Dowlatshahi ◽  
Jayme C. Kosior ◽  
Richard I. Aviv ◽  
...  
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign ◽  
Perihematomal Edema

Abstract 182: "Spot" Sign vs "Dot" Sign as Predictor of Hemorrhagic Stroke Outcomes

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Katherine O Brag ◽  
Erica Jones ◽  
Dominique Monlezun ◽  
Alex George ◽  
Michael Halstead ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Clinical Significance ◽  
Statistical Tests ◽  
Hematoma Expansion ◽  
Poor Functional Outcome ◽  
Spot Sign ◽  
Post Contrast ◽  
Stroke Registry ◽  
Logistic Regression Models

Introduction: Hematoma expansion (HE) is an established predictor of mortality and poor functional outcome after intracerebral hemorrhage (ICH). The computed tomography angiography (CTA) “spot” sign predicts HE and deterioration. The “dot” sign on delayed post-contrast CT (PCCT) has undetermined clinical significance but is thought to represent a slower rate of bleeding than the “spot” sign. We aimed to compare the sensitivity of a “dot” sign with the “spot” sign and establish the clinical significance of the “dot” sign. Methods: Patients with ICH presenting to our center July 2008-May 2013 were identified from our stroke registry. Only patients with baseline CT, CTA and PCCT and follow-up CT 6-36 hours later were included. Patients with clot evacuation between baseline and follow-up CT were excluded. HE was defined as 1) any ≥ 1cc increase and 2) significant ≥ 12.5cc increase or >33% increase in volume. Differences in cohort characteristics were assessed using appropriate statistical tests and sensitivity was calculated from 2x2 tables. Unadjusted logistic regression models were used to investigate the relation of “spot” and “dot” signs with HE and poor functional outcome (discharge mRS 4-6). Results: Of the 210 ICH patients included in the analyses (median age 61, 44.7% female, 66.2% black), 39 (18.5%) patients had a PCCT “dot” sign and 19 (9%) had a CTA “spot” sign. Significant HE occurred in 15% with “dot” sign and 8% with “spot” sign. The PCCT “dot” sign had a sensitivity of 0.52 in predicting significant HE and a sensitivity of 0.69 in predicting discharge mRS 4-6 (compared with 0.24 and 0.30 for “spot” sign, respectively). Patients with a “dot” sign, but without a “spot” sign, had significantly increased odds of any HE (OR 5.7, 95% CI 1.9-17.8, p=0.003), mRS 4-6 (OR 8.1, 95% CI 1.03-64.6, p=0.048), and death (OR 8.1, 95% CI 1.4-48.4, p=0.02), but not significant HE (OR 2.2, 95% CI 0.7-6.7, p=0.15). Conclusions: The PCCT “dot” sign was more sensitive in predicting hematoma expansion than the CTA “spot” sign and predicted hematoma expansion and poor functional outcome even in the absence of the “spot sign.” The utility of PCCT imaging in acute evaluation of ICH patients requires validation, but our study supports clinical relevance of the “dot” sign.

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