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

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

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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