Abstract 77: Ongoing Leakage Revealed by Second Phase Spot Sign Volume Expansion in Multi-Phase Computed Tomography Angiography Strongly Predicts Intracranial Hemorrhage Growth

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abdulaziz Al Sultan ◽  
Ericka Teleg ◽  
MacKenzie Horn ◽  
Piyush Ojha ◽  
Linda Kasickova ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Single Phase ◽  
Meta Analysis ◽  
Hematoma Expansion ◽  
Second Phase ◽  
Hematoma Volume ◽  
Spot Sign ◽  
Time Resolved ◽  
Multi Phase

Background: CTA spot sign is a predictor of intracerebral hemorrhage (ICH) expansion. This sign can fluctuate in appearance, volume, and timing. Multiphase CTA (mCTA) can identify spot sign through 3 time-resolved images. We sought to identify a novel predictor of follow up total hematoma expansion using mCTA. Methods: This cohort study included patients with ICH between 2012-2019. Quantomo software was used to measure total hematoma volume (ml) from baseline CT & follow-up CT/MRI blinded to spot sign in 3 mCTA phases. Spot sign expansion was calculated by subtracting 1 st phase spot sign volume from 2 nd phase spot sign volume measured in microliters. Results: 199 patients [63% male, mean age 69 years, median NIHSS 11, IQR 6-20] were included. Median baseline ICH volume was 16.1 ml (IQR 5-29.9 ml). Amongst all three mCTA phases, spot sign was best detected on the 2nd phase (23% vs 17.5% 1 st phase vs 22% 3 rd phase). In multivariable regression, spot sign expansion was significantly associated with follow up total hematoma expansion (OR: 1.03 per microliter of spot sign expansion, p=0.01). Figure 1 shows the predicted total hematoma expansion by spot sign expansion. mCTA spot sign had a higher sensitivity for predicting total hematoma volume expansion than single-phase CTA (reported in meta-analysis of 14 studies), 86% vs 53%, respectively, while both having similar specificity, 87% vs 88%, respectively. Conclusion: Spot sign expansion on mCTA is a novel predictor of total hematoma expansion and could be used to select patients for immediate therapeutic intervention in future clinical trials. Using mCTA improves sensitivity while preserving specificity over single-phase CTA.

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.

scholarly journals The Accuracy of Spot Sign in Predicting Hematoma Expansion after Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e115777 ◽  
Author(s):  
Fei-Zhou Du ◽  
Rui Jiang ◽  
Ming Gu ◽  
Ci He ◽  
Jing Guan
Keyword(s):  
Systematic Review ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Hematoma Expansion ◽  
Spot Sign

Identification and Prioritization of Generic Nuclear Safety Problems Requiring CFD Analysis

2009 ◽  
Author(s):  
Brian L. Smith
Keyword(s):  
Single Phase ◽  
Safety Issues ◽  
Group A ◽  
Computational Fluid Dynamics Cfd ◽  
Specific Safety ◽  
Multi Phase ◽  
High Cycle Thermal Fatigue ◽  
Specific Concern ◽  
Country Specific

Within the framework of the activities and responsibilities of the OECD/NEA/WGAMA group, a modest PIRT-type exercise was initiated to identify and prioritize country-specific safety issues for which it was considered that analysis using Computational Fluid Dynamics (CFD) could bring real benefits in regard to improved safety. Conventional PIRT procedures were followed as far as possible: the problem scope and objectives of the exercise were first defined, and then a panel of experts was assembled to identify and prioritize the safety items of specific concern to the country represented. Collating the information received, it was possible to identify those safety issues which were clearly country-specific in origin, and those which were of generic interest for which a common approach to benchmarking would be justified. Separate lists were compiled for single-phase and multi-phase phenomena. The paper summarizes the procedures undertaken, lists and prioritizes the safety topics identified in the study, and presents the final ranking in terms of generic importance. Also described are perspectives for a first follow-up activity: the promotion of a new validation benchmark activity based on the problem of high-cycle thermal fatigue in mixing tees.

scholarly journals Admission leukocytosis and its implications on intra cerebral haemorrhage

2021 ◽  
Vol 8 (2) ◽  
pp. 228
Author(s):  
Rajendran Velayudham ◽  
Ramesh Dasarathan ◽  
Nirumal Khumar S. ◽  
Senthil Kumar S.
Keyword(s):  
Volume Expansion ◽  
Cerebral Haemorrhage ◽  
Severe Disabilities ◽  
Definitive Diagnosis ◽  
Hematoma Expansion ◽  
Current Investigation ◽  
Haematoma Expansion ◽  
Catastrophic Disease ◽  
Differential Counts

Background: Intracerebral haemorrhage is one amongst the most common subtype of stroke. It is a catastrophic disease with significant rate of mortality and may lead to severe disabilities. Immediate and effective treatment is a prime requisite of ICH, as rapid mortality occurs within first 24 hours. Definitive diagnosis of ICH is difficult as its symptoms are similar to ischemic stroke. Aim of current investigation was to establish a relationship between intra-cerebral haemorrhage and leukocytosis and to use it as an early tool for detecting haematoma expansion for prognostication and developing newer drugs using a suitable therapeutic target.  Methods: Current investigation was an observational study carried out on 100 patients with intra-cerebral haemorrhage. Differential counts were studied with respect to influence of particular subtypes on hematoma expansion. Follow up NCCT was done after 48 hours of the event.  Results: Results of present investigation revealed that mean age of the patients was 56 years, 82% were males and all the patients were hypertensive. It was observed that majority of patients with neutrophilic leukocytosis, did not show hematoma expansion and neutrophilic leukocytosis was preferentially present in patients with higher initial bleed volumes. Significant association was observed between monocytosis and haematoma expansion and association between lymphocytosis and volume expansion was observed to be non-significant.  Conclusions: Current study findings can aid in early risk stratification and prognostication of ICH patients and can also provide a tool for identification of new therapeutic targets for controlling haematoma expansion.

Abstract 114: The Predictive Ability of the CTA Spot Sign for Hematoma Expansion is Dependent on Time Since ICH Onset: A Systematic Review and Patient-level Meta-analysis.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dar Dowlatshahi ◽  
Bart Brouwers ◽  
Andrew Demchuk ◽  
Michael D Hill ◽  
Richard Aviv ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Predictive Ability ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Cochrane Central Register ◽  
Contrast Extravasation ◽  
Spot Sign ◽  
Predictive Values ◽  
Patient Level ◽  
Chi Square Analysis

Background: Hematoma expansion (HE) occurs in up to 40% of patients with intracerebral hemorrhage (ICH), and predicts poor clinical outcome. Contrast extravasation following CT-angiography (CTA), termed “spot sign”, identifies patients at highest risk of HE. However, the prevalence and predictive values of the spot sign varies across studies, possibly due to differences in onset-to-CTA time. We therefore performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and the prevalence & predictive value of spot sign, and the size of HE. Methods: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Library Database of Systematic Reviews, MEDLINE and EMBASE for studies of CTA spot sign prevalence and HE. We pooled data on the prevalence and predictive values for significant HE (defined as either 6mL or 33% growth of ICH) for patients with ICH stratified by onset-to-CTA time: <3hours, 3-6 hours, >6hours. We used chi-square analysis to assess the spot sign in each time strata, and two-way ANOVA to compare across time strata. Results: We identified ICH spot sign databases derived from 7 countries and 14 centers (n=705). Prevalence of spot sign decreased with increasing onset-to-CTA time (Table; p<0.001). The subset with follow-up scans used for HE analysis (n=582) revealed spot sign sensitivity and PPV were highest in the earliest time strata, whereas specificity and NPV were highest in the latest time strata (Table). Spot positive patients had greatest absolute HE in the earlier CTA time strata (median spot positive growth 6.8mL, 5.6mL, 5.2mL for 6hr respectively; p<0.001; means in Table). Conclusion: Prevalence, predictive values and magnitude of effect of the spot sign are dependent on onset-to-CTA timing; these results are relevant to both ICH trial design and acute management.

scholarly journals Volume and Characteristics of Intracerebral Hemorrhage with Direct Oral Anticoagulants in Comparison with Warfarin

2017 ◽  
Vol 7 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Tomohide Adachi ◽  
Haruhiko Hoshino ◽  
Makoto Takagi ◽  
Shodo Fujioka ◽  
Keyword(s):  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Univariate Analysis ◽  
Anticoagulation Therapy ◽  
Hematoma Expansion ◽  
Hematoma Volume ◽  
Cross Sectional ◽  
Warfarin Group ◽  
Computed Tomography Scanning

Background: Patients undergoing anticoagulation therapy often experience intracerebral hemorrhages (ICHs), and warfarin in particular is known to increase hematoma expansion in ICHs, which results in a poor outcome. Recent studies reported that, in comparison with warfarin, direct oral anticoagulants (DOACs) cause fewer ICHs with better functional outcome. However, since it is still unknown whether DOACs are associated with a smaller hematoma volume of ICHs, we aimed to compare the volume, hematoma expansion, and outcomes associated with ICHs treated with DOACs and warfarin. Methods: We performed a prospective multicenter cross-sectional study. The subjects included patients with acute ICHs who received either DOACs or warfarin. We evaluated the clinical characteristics, and measured initial and follow-up ICH volumes. The volume of ICHs and hematoma expansion were compared between the DOAC and warfarin groups. Mortality and modified Rankin score at discharge were evaluated as outcomes. Results: There were 18 patients in the DOAC group and 71 in the warfarin group. The baseline characteristics were similar between the 2 groups. Initial median hematoma volume of ICHs in the DOAC group was significantly lower than that in the warfarin group (6.2 vs. 24.2 mL, respectively; p = 0.04). In cases involving follow-up computed tomography scanning, the median hematoma volume of ICHs at follow-up was lower in the DOAC group than in the warfarin group (initial: DOACs 4.4 vs. warfarin 13.5 mL; follow-up: 5.0 vs. 18.4 mL, respectively; p = 0.05). Further, the hematoma in ICHs associated with DOACs did not expand. Although the mortality of ICHs associated with DOACs (11%) was lower than that associated with warfarin (24%), this difference was not statistically significant. The univariate analysis showed that the anticoagulant type (DOACs vs. warfarin) and sex (male vs. female) were associated with ICH volume. The multivariable linear regression showed that the use of DOACs (compared to warfarin; β: –0.23, p = 0.03) and female sex (compared to male; β: –0.25, p = 0.02) were associated with a small hematoma volume. Conclusions: Based on the results of the present study, in terms of the risks associated with ICHs, the use of DOACs appears to be safer than warfarin for anticoagulation therapy. Further studies are required to validate these findings.

scholarly journals The Function of Tranexamic Acid to Prevent Hematoma Expansion After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis From Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Zeya Yan ◽  
Shujun Chen ◽  
Tao Xue ◽  
Xin Wu ◽  
Zhaoming Song ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Statistical Difference ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Hematoma Volume ◽  
Randomized Controlled

Objectives: The clinical results caused by spontaneous intracerebral hemorrhage (ICH) are disastrous to most patient. As tranexamic acid (TXA) has been proved to decrease the influence of ICH, we conducted this research to explore the function of TXA for the prognosis of ICH compared with placebo.Methods: We searched MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov for randomized controlled trials (RCTs) that were performed to evaluate TXA vs. placebo for ICH up to February 2021. The data were assessed by Review Manager 5.3 software. The risk ratio (RR) and mean difference were analyzed using dichotomous outcomes and continuous outcomes, respectively, with a fixed effect model.Results: We collected 2,479 patients from four RCTs. Then, we took the change of hematoma volume, modified Rankin Scale (mRS), and adverse events as evaluation standard of the treatment for ICH. Through statistical analysis, we found that there is no obvious hematoma expansion effect after the application of TXA (RR = 1.05), and we proceeded the quantitative analysis of percentage change in hematoma volume from baseline, indicating that TXA could inhibit the expansion of hematoma volume (RR = −2.02) compared with placebo. However, according to the outcomes of mRS (0–1, RR = 1.04; 0–2, RR = 0.96), TXA cannot improve neurological functional prognosis. As for the security outcomes—mortality (RR = 1.02), thromboembolic events (RR = 0.99), neurological deterioration (RR = 0.92), infection (RR = 0.86), and craniotomy (RR = 0.41), there seems exist no statistical difference between TXA and placebo.Conclusions: TXA has an advantage in the aspect of preventing hematoma expansion compared with placebo for ICH, but cannot illustrate the efficacy of TXA in improving neurological functional prognosis, which still needs more researches with large sample sizes. Moreover, for safety, we did not find obvious statistical difference between TXA and placebo.

Abstract WP293: Baseline Perihematomal Edema is Greater in the Presence of a CTA Spot Sign but Does Not Predict Hematoma Expansion Independent of ICH Volume

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David Rodriguez-Luna ◽  
Teri Stewart ◽  
Suresh Subramaniam ◽  
Dar Dowlatshahi ◽  
Jayme C Kosior ◽  
...  
Keyword(s):  
Ct Scan ◽  
Small Degree ◽  
Hematoma Expansion ◽  
Study Cohort ◽  
Lesion Volume ◽  
Spot Sign ◽  
Observational Cohort ◽  
Axial Ct ◽  
Perihematomal Edema

Background: Similarly to intracerebral hemorrhage (ICH), perihematomal edema (PHE) increases with time from onset. A small degree of PHE relative to ICH may suggest a very early timepoint from onset or actively bleeding ICH and therefore predict a higher likelihood of hematoma expansion (HE). The relationship between PHE, ICH and HE has not however been established. Therefore, we aimed to investigate the link between PHE and ICH by time and their relationship with the CTA spot sign and HE. Methods: The PREDICT study was a multicentric, prospective, observational cohort study of ICH patients <6 hours. All study cohort subjects with available baseline CT scan images (n=377) were included in this analysis. Volumes and diameters of total lesion, ICH and PHE were measured systematically by two blinded investigators, respectively. Diameter measurements were taken in the axial CT slice with the largest ICH area. Significant HE was defined as ICH enlargement >33% or >6mL at 24 hours. Results: Correlation between volume and diameter measurements was strong for total lesion (r=0.9; p<0.001) and ICH (r=0.88; p<0.001), but moderate for PHE (r=0.43; p<0.001). PHE represented a half of the total lesion volume at baseline (Table). PHE volume and diameter were not related to time from onset to baseline CT, although PHE/ICH diameter (p=0.017) and volume (p=0.061) ratios were higher the later the baseline CT scan was performed. Spot-sign patients (29.7%) had more baseline PHE, ICH and total lesion than spot-negative patients (Table). HE analysis was limited to 322 patients with follow-up CT before rFVIIa or surgical intervention. HE patients (32%) presented with higher PHE, ICH and total lesion volumes (Table). Baseline PHE diameter and volume ratios however did not predict subsequent HE. Conclusion: Edema represents about half of total lesion volume in acute ICH. Edema and ICH are larger in the presence of a CTA spot sign. Edema alone does not predict subsequent hematoma expansion.

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