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.

Abstract WP372: The Acute ICH Growth Score: Simple and Accurate Predictor of Hematoma Expansion in Patients with Acute Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
F S Al-Ajlan ◽  
A M Demchuk ◽  
R I Aviv ◽  
D Rodriguez-Luna ◽  
C Molina ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Area Under The Curve ◽  
Hematoma Expansion ◽  
Blood Levels ◽  
Spot Sign ◽  
Mortality And Morbidity ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage ◽  
Score Model ◽  
Multicenter Prospective Study

Background and Purpose: Acute intracerebral hemorrhage (ICH) hematoma expansion predicts high mortality and morbidity, occurring in a third of patients presenting with this condition. Recent studies correlated ultra-early hematoma growth and hematoma morphologic appearance with ICH expansion. Our purpose was to develop simple and clinically useful score that would predict ICH hematoma expansion accurately. Methods: This cohort included patients with primary or anticoagulation-associated ICH patients presenting <6 hours post ictus prospectively enrolled in the PREDICT study. Patients underwent baseline CT, CT angiography and 24-hour CT for hematoma expansion analysis. A risk score model was developed for predicting hematoma expansion (> 6 ml or > 33%). A 7-point acute ICH growth score was based on ultra-early hematoma growth > 5 mL/hour (yes=1), irregular morphology (yes=1), density heterogeneity (yes=1), presence of fluid-blood levels (yes=1), spot sign (yes=1), and use of anticoagulation (yes=2). Discrimination of the expansion score was assessed. Results: We retrospectively studied 301 primary or anticoagulation-associated intracerebral hemorrhage patients. The 7-point acute ICH growth score demonstrated good discrimination for hematoma expansion>6 mL or 33% (area under the curve of 0.76). Median and significant HE are shown in the table below (p<0.001). Conclusions: In a multicenter prospective study, the ICH expansion score demonstrate good correlation with hematoma expansion, and included recently reported variables such as morphology and ultraearly growth.

Abstract TP337: Multiphase CTA Improves ICH Expansion Prediction and Might Provide Additional Information on the Pathophysiology of the Spot Sign

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Rodriguez-Luna ◽  
Pilar Coscojuela ◽  
Noelia Rodriguez-Villatoro ◽  
Jesus M Juega ◽  
Sandra Boned ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Strong Predictor ◽  
Phase 1 ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
Predictive Values ◽  
Additional Information ◽  
Active Hemorrhage ◽  
Observational Cohort ◽  
Hematoma Growth

Background: Although the spot sign is a strong predictor of hematoma expansion, there is no accepted consensus on the timing of CTA acquisition, mainly because its pathophysiologic significance is uncertain. We investigated the yield of the spot sign in the prediction of hematoma expansion and its pathophysiological underpinnings using multiphase CTA. Methods: Single-center prospective observational cohort study of 123 consecutive patients with acute (<6 hours) ICH. Patients underwent multiphase CTA performed in 3 automated phases after contrast dye injection (delay of 8, 4, and 15 seconds, respectively). According to spot sign positivity in the 3 phases, patients were categorized into 1 of 4 patterns: A (+/+/-), B (+/+/+), C (-/+/+), and D (-/-/+). Outcomes included frequency of the spot sign, significant hematoma expansion at 24 hours (>33% or >6 mL, primary outcome), and absolute hematoma growth. Results: The frequency of the spot sign was higher the later the phase of CTA was: 29.3% in phase 1, 43.1% in 2, and 46.3% in 3 ( P <0.001). The presence of the spot sign in phase 1, 2, 3, or any phase was related to significant hematoma expansion ( P <0.001 for all comparisons). Predictive values varied depending on the CTA phase, with highest PPV observed in phase 1 (63%) and highest NPV in phase 2 (88.9%). Onset to imaging time was not significantly lower the more arterial the pattern of spot sign presentation was (Figure). The frequency of significant hematoma expansion was higher the earlier the pattern of spot sign presentation: A 100%, B 59.1%, C 40%, and D 0% ( P =0.013). Absolute hematoma growth analysis showed a hierarchical distribution of patterns of spot sign presentation: A > B > C > D > no spot sign ( P =0.003, Figure). Conclusions: Multiphase CTA improves hematoma expansion prediction and might provide additional information on the pathophysiology of the spot sign. Arterial spot signs may represent the point of active hemorrhage, and venous spot signs the site of resolved bleeding.

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 Hemostatic Therapy in Experimental Intracerebral Hemorrhage Associated With the Direct Thrombin Inhibitor Dabigatran

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3594-3599 ◽  
Author(s):  
Wei Zhou ◽  
Sönke Schwarting ◽  
Sergio Illanes ◽  
Arthur Liesz ◽  
Moritz Middelhoff ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Human Factor ◽  
Bleeding Time ◽  
Factor Viia ◽  
Fresh Frozen Plasma ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Fresh Frozen ◽  
Hematoma Growth ◽  
Frozen Plasma

Background and Purpose— Dabigatran-etexilate (DE) recently has been approved for stroke prevention in atrial fibrillation. However, lack of effective antagonists represents a major concern in the event of intracerebral hemorrhage (ICH). The aims of the present study were to establish a murine model of ICH associated with dabigatran, and to test the efficacy of different hemostatic factors in preventing hematoma growth. Methods— In C57BL/6 mice receiving DE (4.5 or 9.0 mg/kg), in vivo and in vitro coagulation assays and dabigatran plasma levels were measured repeatedly. Thirty minutes after inducing ICH by striatal collagenase injection, mice received an intravenous injection of saline, prothrombin complex concentrate (PCC; 100 U/kg), murine fresh-frozen plasma (200 μL), or recombinant human factor VIIa (8.0 mg/kg). ICH volume was quantified on brain cryosections 24 hours later. Results— DE substantially prolonged tail vein bleeding time and ecarin clotting time for 4 hours corresponding to dabigatran plasma levels. Intracerebral hematoma expansion was observed mainly during the first 3 hours on serial T2* MRI. Anticoagulation with high doses of DE increased the hematoma volume significantly. PCC and, less consistently, fresh-frozen plasma prevented excess hematoma expansion caused by DE, whereas recombinant human factor VIIa was ineffective. Prevention of hematoma growth and reversal of tail vein bleeding time by PCC were dose-dependent. Conclusions— The study provides strong evidence that PCC and, less consistently, fresh-frozen plasma prevent excess intracerebral hematoma expansion in a murine ICH model associated with dabigatran. The efficacy and safety of this strategy must be further evaluated in clinical studies.

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.

Added value of delayed computed tomography angiography in primary intracranial hemorrhage and hematoma size for predicting spot sign

2017 ◽  
Vol 59 (4) ◽  
pp. 485-490 ◽  
Author(s):  
Te Chang Wu ◽  
Tai Yuan Chen ◽  
Yow Ling Shiue ◽  
Jeon Hor Chen ◽  
Tsyh-Jyi Hsieh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Computed Tomography Angiography ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Added Value ◽  
Hematoma Expansion ◽  
Contrast Extravasation ◽  
Spot Sign

Background The computed tomography angiography (CTA) spot sign represents active contrast extravasation within acute primary intracerebral hemorrhage (ICH) and is an independent predictor of hematoma expansion (HE) and poor clinical outcomes. The spot sign could be detected on first-pass CTA (fpCTA) or delayed CTA (dCTA). Purpose To investigate the additional benefits of dCTA spot sign in primary ICH and hematoma size for predicting spot sign. Material and Methods This is a retrospective study of 100 patients who underwent non-contrast CT (NCCT) and CTA within 24 h of onset of primary ICH. The presence of spot sign on fpCTA or dCTA, and hematoma size on NCCT were recorded. The spot sign on fpCTA or dCTA for predicting significant HE, in-hospital mortality, and poor clinical outcomes (mRS ≥ 4) are calculated. The hematoma size for prediction of CTA spot sign was also analyzed. Results Only the spot sign on dCTA could predict high risk of significant HE and poor clinical outcomes as on fpCTA ( P < 0.05). With dCTA, there is increased sensitivity and negative predictive value (NPV) for predicting significant HE, in-hospital mortality, and poor clinical outcomes. The XY value (product of the two maximum perpendicular axial dimensions) is the best predictor (area under the curve [AUC] = 0.82) for predicting spot sign on fpCTA or dCTA in the absence of intraventricular and subarachnoid hemorrhage. Conclusion This study clarifies that dCTA imaging could improve predictive performance of CTA in primary ICH. Furthermore, the XY value is the best predictor for CTA spot sign.

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
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