Abstract TP338: The Dynamic CT Angiography Spot Sign: Prevalence, Predictive Value, and Rate of Contrast Extravasation

Introduction: Hematoma expansion is a predictor of poor clinical outcome in intracerebral hemorrhage (ICH). The CT angiography (CTA) spot sign is a validated predictor of hematoma expansion, but its predictive performance is modest. This is in part because traditional “static” CTA can miss delayed spot signs, depending on the timing of image acquisition. Dynamic CTA (dCTA) can detect delayed spot sign formation and allows calculation of contrast extravasation rate. However, the predictive performance of a delayed “dynamic spot” and the relationship between rate of extravasation and hematoma expansion are not known. Our primary objective was to calculate the prevalence and predictive performance of the dynamic spot sign with dCTA. Our secondary objective was to determine whether the rate of contrast extravasation predicts significant hematoma expansion. Methods: We prospectively enrolled 79 patients who presented with primary ICH and underwent dCTA within 6 hours from onset. Primary outcomes were the prevalence of dCTA spot sign and its predictive performance for significant hematoma expansion (increase in hematoma by 6mL or 33% from baseline). For the secondary objective, we calculated the rate of contrast extravasation as the slope of the time curve from the first appearance of contrast at a spot sign to the maximal volume of contrast in 19 acquisitions over 60 seconds. We assessed the relationship between rate of extravasation and hematoma expansion using Mann-Whitney U test and logistic regression. Results: The prevalence of the dCTA spot sign was 45.6% (95% CI, 34.5-56.6%). Significant HE was seen in 58.1% (18/31) of spot-positive patients versus 29.0% (9/31) of spot-negative patients (P=0.04). The sensitivity and specificity of the dCTA spot sign in predicting significant HE was 67% and 63%, respectively. Median rate of extravasation was 0.0022 mL/min in patients with hematoma expansion vs 0.0013 mL/min in those without (p=0.05). Conclusion: Dynamic CTA had a higher spot sign prevalence than conventional CTA. While the sensitivity in predicting expansion was higher with dCTA, the specificity was lower, possibly due to a lower risk of expansion with delayed spot signs. The rate of extravasation was roughly double in patients with hematoma expansion.

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

Acta Radiologica ◽

10.1177/0284185117718401 ◽

2017 ◽

Vol 59 (4) ◽

pp. 485-490 ◽

Cited By ~ 2

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.

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Abstract 3729: Delayed Hematoma Expansion Occurs After ICH: Observations from the Safety of Pioglitazone for Hematoma Resolution in INtraCerebral Hemorrhage (SHRINC) trial

Stroke ◽

10.1161/str.43.suppl_1.a3729 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Navdeep S Sangha ◽

Farhaan Vahidy ◽

Mallikarjunarao Kasam ◽

Mohammed Rahbar ◽

Bursaw Andrew ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Prospective Study ◽

Univariate Analysis ◽

Primary Objective ◽

Hematoma Expansion ◽

Hematoma Growth ◽

Secondary Objective ◽

Magnetic Resonance Imaging Mri ◽

Associated Risk Factors

Background and Purpose Early hematoma expansion (EHE) has been described in the first 48 hours. SHRINC is a phase 2 prospective safety trial whose primary objective is to assess the safety of pioglitazone (PIO) when administered to patients with spontaneous intracerebral hemorrhage (SICH) compared to standard care. A secondary objective is to characterize the changes in hematoma resolution and expansion over time. This prospective study addresses the natural history, clinical impact, and associated risk factors of late hematoma expansion (LEX) by serial magnetic resonance imaging (MRI) after SICH. Methods SHRINC aims to enroll 78 subjects between the ages of 18-80 with a SICH of ≥ 5 ml. This analysis includes the first 42 patients enrolled. Four subjects were excluded because they did not have an MRI after day 2. A baseline CTH was performed followed by an MRI within 24 hours of symptom onset. Hematoma volume (Hv) was measured on FLAIR sequences using a previously published semi-automated range of interest method. LEX was defined as an increase in Hv > 0.5 ml after the 48 hour MRI. Factors associated with LEX were evaluated with logistic regression. Longitudinal analyses were used for measurements taken over the follow up period. Results: Ten (26.3%) of 38 subjects displayed LEX. Eight subjects had LEX between day 2 to 14, and 4 between days 14 to 28. The median initial Hv was 16.1cc in LEX patients and 24.1cc in those without expansion (NEX) (p=0.23). Lower platelet counts (p=0.04) and BUN levels (p=0.03) were associated with LEX in univariate analysis. Multivariate analysis suggested that those with higher BUN levels were less likely to have LEX (OR=0.81; 95%CI 0.65-0.99). Blood pressure and EHE (13.2%) were not associated with LEX. There was no difference in neurological worsening (NIHSS increase ≥ 4), 6 month mRS or death between LEX and NEX. Conclusion: This is the first prospective study to address LEX with serial MRIs. LEX occurs between day 2 to 14 and day 14 to 28. Elevated BUN levels may decrease the likelihood of LEX. A limitation of our study is that the effect of PIO on LEX could not be evaluated because SHRINC is a blinded trial. Further studies will assess the pathophysiology of LEX and its potential implications in clinical trials evaluating hematoma growth and resolution.

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Protocol: The relationship between vitamin A and body mass: A systematic review and meta-analysis

10.7287/peerj.preprints.27071v1 ◽

2018 ◽

Author(s):

Wasim A Iqbal ◽

Gavin B Stewart ◽

Ines Mendes ◽

Kieran Finney ◽

Anthony Oxley ◽

...

Keyword(s):

Systematic Review ◽

Adipose Tissue ◽

Vitamin A ◽

Body Mass ◽

Meta Analysis ◽

Primary Objective ◽

Risk Of Bias ◽

Adipose Tissue Depots ◽

Secondary Objective ◽

The Relationship

The proposed protocol is for a systematic review and meta-analysis on the relationship between vitamin A and body mass. The primary objective is to explore the mechanisms between vitamin A and adiposity such as inflammation, dietary intake and body fat. The secondary objective is to look at the extent to which vitamin A is stored in different adipose tissue depots. The protocol outlines the motive and scope for the review, and methodology including the risk of bias, statistical analysis, screening and study criteria.

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The Influence of Socioeconomic Status on Snacking and Weight among Adolescents: A Scoping Review

Nutrients ◽

10.3390/nu12010167 ◽

2020 ◽

Vol 12 (1) ◽

pp. 167 ◽

Cited By ~ 3

Author(s):

Victoria G. Williamson ◽

Abhaya Dilip ◽

Jackson R. Dillard ◽

Jane Morgan-Daniel ◽

Alexandra M. Lee ◽

...

Keyword(s):

Socioeconomic Status ◽

Scoping Review ◽

Eating Behaviors ◽

Preliminary Evidence ◽

Primary Objective ◽

Bibliographic Databases ◽

Increased Risk ◽

Potential Link ◽

Secondary Objective ◽

The Relationship

Eating behaviors, including unhealthy snacking or excessive snacking leading to excess calorie consumption, may contribute to obesity among adolescents. Socioeconomic status (SES) also significantly influences eating behaviors, and low SES is associated with increased risk for obesity. However, little is known regarding the relationship between snacking behavior and SES among adolescents and how this may contribute to obesity-related outcomes. The primary objective of this scoping review was to review the literature to assess and characterize the relationship between SES and snacking in adolescents. The secondary objective was to assess weight-related outcomes and their relation to snacking habits. Included articles were published between January 2000 and May 2019; written in English, Portuguese, or Spanish; and focused on adolescents (13–17 years). In total, 14 bibliographic databases were searched, and seven studies met the inclusion criteria. Preliminary evidence from the seven included studies suggests a weak but potential link between SES and snacking. Additionally, these dietary patterns seemed to differ by sex and income type of country. Finally, only three of the included studies addressed weight-related outcomes, but the overall available evidence suggests that snacking does not significantly affect weight-related outcomes. Due to the small number of included studies, results should be interpreted with caution.

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Role of 'Spot Sign' on CT Angiography to Predict Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2010.48.5.399 ◽

2010 ◽

Vol 48 (5) ◽

pp. 399 ◽

Cited By ~ 32

Author(s):

Soo Yong Park ◽

Min Ho Kong ◽

Jung Hee Kim ◽

Dong Soo Kang ◽

Kwan Young Song ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Hematoma Expansion ◽

Spontaneous Intracerebral Hemorrhage ◽

Spot Sign

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An Empirical Perspective on Visual Icon Design

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129804200501 ◽

1998 ◽

Vol 42 (5) ◽

pp. 448-451

Author(s):

Andrew Sears ◽

Julie A. Jacko ◽

Byron Brewer ◽

Lylliam D. Robelo

Keyword(s):

Primary Objective ◽

Free Form ◽

Perceived Effectiveness ◽

Frequency Of Use ◽

Secondary Objective ◽

Empirical Perspective ◽

Graphic Image ◽

Iconic Representations ◽

The Relationship

The primary objective of this study is to evaluate two methods for assessing the quality of iconic representations of computer functionality. A secondary objective is to explore the relationship between frequency of use of specific computer functions and icon usage. These objectives were accomplished by investigating the identifiability, perceived effectiveness, and frequency of use of 34 icons used in the standard and formatting toolbars of Microsoft® Word 7.0. More specifically, our data provide information regarding the perceived effectiveness of the iconic representation given its associated functionality, free-form recall of associated functionality given only the icon, frequency of use of the functionality (either by access through the icon or the menu) and frequency of icon use. To accomplish our objectives, we constructed and administered a four-part survey to 353 volunteers. The results compose the first empirically documented evidence that icon use is not merely a function of how frequently users access the functionality the icon is designed to represent. The results also suggests that the ability of users to correctly identify the functionality of an icon given only the graphic image may be an effective method of evaluating the quality of alternative icon designs.

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A Study of CT- Angiography Spot sign as a predictor of Hematoma expansion in patients with primary intracerebral Haemorrhage

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v6i5.24 ◽

2018 ◽

Vol 6 (5) ◽

Author(s):

Sujin Koshy ◽

Keyword(s):

Ct Angiography ◽

Intracerebral Haemorrhage ◽

Hematoma Expansion ◽

Spot Sign

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Abstract W P257: Predictors of the CT Angiography Spot Sign in Deep and Lobar Intracerebral Hemorrhage

Stroke ◽

10.1161/str.45.suppl_1.wp257 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Farid Radmanesh ◽

Guido J Falcone ◽

Christopher D Anderson ◽

Thomas W Battey ◽

Alison M Ayres ◽

...

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Cerebral Amyloid Angiopathy ◽

Symptom Onset ◽

Hematoma Expansion ◽

Amyloid Angiopathy ◽

Spot Sign ◽

Increased Risk ◽

Cerebral Amyloid

Objectives: Intracerebral hemorrhage (ICH) patients with CT angiography (CTA) spot sign are at increased risk of hematoma expansion and poor outcome. Since ICH is often the acute manifestation of a chronic cerebral vasculopathy, we investigated whether different clinical or imaging characteristics predict spot sign presence in patients with different underlying vasculopathies. Using ICH location as a surrogate for hypertension-related ICH and cerebral amyloid angiopathy-related ICH, we identified risk factors associated with spot sign. METHODS: We retrospectively analyzed a prospective cohort of consecutive spontaneous ICH patients with available CTA. Spot sign presence was ascertained by two independent readers blinded to clinical data. We assessed potential predictors of spot sign be performing uni- and multivariable logistic regression, analyzing deep and lobar ICH separately. RESULTS: 649 patients were eligible, 291 (45%) deep and 358 (55%) lobar ICH. Median time from symptom onset to CTA was 4.5 (IQR 5.2) and 5.7 (IQR 7.4) hours in patients with deep and lobar ICH, respectively. At least one spot sign was present in 76 (26%) deep and 103 (29%) lobar ICH patients. In mutivariable logistic regression, independent predictors of spot sign in deep ICH were warfarin (OR 2.82 [95%CI 1.06-7.57]; p=0.03), time from symptom onset to CTA (OR 0.9 [95%CI 0.81-0.97]; p=0.02), and baseline ICH volume (OR 1.27 [95%CI 1.14-1.43]; p=2.5E-5; per 10 mL increase). Predictors of spot sign in lobar ICH were preexisting dementia (OR 2.7 [95%CI 1.15-6.43]; p=0.02), warfarin (OR 4.01 [95%CI 1.78-9.29]; p=0.009), and baseline ICH volume (OR 1.27 [95%CI 1.17-1.39]; p=5.4E-8; per 10 mL increase). As expected, spot sign presence was a strong predictor of hematoma expansion in both deep (OR 3.52 [95%CI 1.72-7.2]; p=0.0005) and lobar ICH (OR 6.53 [95%CI 3.23-13.44]; p=2.2E-7). CONCLUSIONS: The most potent associations with spot sign are shared by deep and lobar ICH, suggesting that ICH caused by different vasculopathic processes share biological features. The relationship between preexisting dementia and spot sign in lobar ICH, but not deep ICH, suggests that ICH occurring in the context of more advanced cerebral amyloid angiopathy may be more likely to have prolonged bleeding.

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