scholarly journals Spot Sign on 90-Second Delayed Computed Tomography Angiography Improves Sensitivity for Hematoma Expansion and Mortality

Stroke ◽  
2014 ◽  
Vol 45 (11) ◽  
pp. 3293-3297 ◽  
Author(s):  
Viesha A. Ciura ◽  
H. Bart Brouwers ◽  
Raffaella Pizzolato ◽  
Claudia J. Ortiz ◽  
Jonathan Rosand ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Hematoma Expansion ◽  
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

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 Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Sanjula D. Singh ◽  
Marco Pasi ◽  
Floris H.B.M. Schreuder ◽  
Andrea Morotti ◽  
Jasper R. Senff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Outcome ◽  
Computed Tomography Angiography ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Case Fatality ◽  
Hematoma Expansion ◽  
Day Case ◽  
Poor Functional Outcome ◽  
Spot Sign

Background and Purpose: The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. Methods: We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression. Results: Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P =0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P =0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P =0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P =0.047) and more likely to be female (71% versus 37%, P =0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P =0.033). Conclusions: In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.

scholarly journals Spot Sign Number Is the Most Important Spot Sign Characteristic for Predicting Hematoma Expansion Using First-Pass Computed Tomography Angiography

Stroke ◽  
2013 ◽  
Vol 44 (4) ◽  
pp. 972-977 ◽  
Author(s):  
Thien J. Huynh ◽  
Andrew M. Demchuk ◽  
Dar Dowlatshahi ◽  
David J. Gladstone ◽  
Özlem Krischek ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
First Pass

scholarly journals Systematic Characterization of the Computed Tomography Angiography Spot Sign in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk for Hematoma Expansion

Stroke ◽  
2009 ◽  
Vol 40 (9) ◽  
pp. 2994-3000 ◽  
Author(s):  
Josser E. Delgado Almandoz ◽  
Albert J. Yoo ◽  
Michael J. Stone ◽  
Pamela W. Schaefer ◽  
Joshua N. Goldstein ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Computed Tomography Angiography ◽  
Hematoma Expansion ◽  
Spot Sign

“On the Spot”: The Use of Four-Dimensional Computed Tomography Angiography to Differentiate a True Spot Sign From a Distal Intracranial Aneurysm

2017 ◽  
Vol 105 ◽  
pp. 1037.e9-1037.e12 ◽  
Author(s):  
Johanna P. de Jong ◽  
Leo Kluijtmans ◽  
Martinus J. van Amerongen ◽  
Mathias Prokop ◽  
Hieronymus D. Boogaarts ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracranial Aneurysm ◽  
Computed Tomography Angiography ◽  
Spot Sign

scholarly journals The Striate Artery, Hematoma, and Spot Sign on Coronal Images of Computed Tomography Angiography in Putaminal Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (7) ◽  
pp. 1830-1832 ◽  
Author(s):  
Takatoshi Sorimachi ◽  
Takahiro Osada ◽  
Tanefumi Baba ◽  
Go Inoue ◽  
Hideki Atsumi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Computed Tomography Angiography ◽  
Spot Sign

scholarly journals Tranexamic Acid for Prevention of Hematoma Expansion in Intracerebral Hemorrhage Patients With or Without Spot Sign

Stroke ◽  
2021 ◽  
Author(s):  
Christian Ovesen ◽  
Janus Christian Jakobsen ◽  
Christian Gluud ◽  
Thorsten Steiner ◽  
Zhe Law ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
Main Trial ◽  
Acid Versus ◽  
Acute Intracerebral Hemorrhage

Background and Purpose: The computed tomography angiography or contrast-enhanced computed tomography based spot sign has been proposed as a biomarker for identifying on-going hematoma expansion in patients with acute intracerebral hemorrhage. We investigated, if spot-sign positive participants benefit more from tranexamic acid versus placebo as compared to spot-sign negative participants. Methods: TICH-2 trial (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) was a randomized, placebo-controlled clinical trial recruiting acutely hospitalized participants with intracerebral hemorrhage within 8 hours after symptom onset. Local investigators randomized participants to 2 grams of intravenous tranexamic acid or matching placebo (1:1). All participants underwent computed tomography scan on admission and on day 2 (24±12 hours) after randomization. In this sub group analysis, we included all participants from the main trial population with imaging allowing adjudication of spot sign status. Results: Of the 2325 TICH-2 participants, 254 (10.9%) had imaging allowing for spot-sign adjudication. Of these participants, 64 (25.2%) were spot-sign positive. Median (interquartile range) time from symptom onset to administration of the intervention was 225.0 (169.0 to 310.0) minutes. The adjusted percent difference in absolute day-2 hematoma volume between participants allocated to tranexamic versus placebo was 3.7% (95% CI, −12.8% to 23.4%) for spot-sign positive and 1.7% (95% CI, −8.4% to 12.8%) for spot-sign negative participants ( P heterogenity =0.85). No difference was observed in significant hematoma progression (dichotomous composite outcome) between participants allocated to tranexamic versus placebo among spot-sign positive (odds ratio, 0.85 [95% CI, 0.29 to 2.46]) and negative (odds ratio, 0.77 [95% CI, 0.41 to 1.45]) participants ( P heterogenity =0.88). Conclusions: Data from the TICH-2 trial do not support that admission spot sign status modifies the treatment effect of tranexamic acid versus placebo in patients with acute intracerebral hemorrhage. The results might have been affected by low statistical power as well as treatment delay. REGISTRATION: URL: http://www.controlled-trials.com ; Unique identifier: ISRCTN93732214.

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