scholarly journals Triage of 5 Noncontrast Computed Tomography Markers and Spot Sign for Outcome Prediction After Intracerebral Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2317-2322 ◽  
Author(s):  
Peter B. Sporns ◽  
André Kemmling ◽  
Michael Schwake ◽  
Jens Minnerup ◽  
Jawed Nawabi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Outcome Prediction ◽  
Spot Sign ◽  
Noncontrast Computed Tomography

scholarly journals Prognostic Value of Non-Contrast CT Markers and Spot Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage under Oral Anticoagulation

2020 ◽  
Vol 9 (4) ◽  
pp. 1077
Author(s):  
Sebastian Zimmer ◽  
Jörn Meier ◽  
Jens Minnerup ◽  
Moritz Wildgruber ◽  
Gabriel Broocks ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Oral Anticoagulation ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Outcome Prediction ◽  
Spot Sign ◽  
Swirl Sign

Introduction: In patients with spontaneous intracerebral hemorrhage (ICH), several non-contrast computed tomography (NCCT) markers and the spot sign (SS) in computed tomography (CT) angiography (CTA) have been established for the prediction of hematoma growth and neurological outcome. However, the prognostic value of these markers in patients under oral anticoagulation (ORAC) is unclear. We hypothesized that outcome prediction by these imaging markers may be significantly different between patients with and without ORAC. Therefore, we aimed to investigate the predictive value of NCCT markers and SS in patients with ICH under ORAC. Methods: This is a retrospective study of the database for patients with ICH at a German tertiary stroke center. Inclusion criteria were (1) patients with ICH, (2) oral anticoagulation within the therapeutic range, and (3) NCCT and CTA performed on admission within 6 h after onset of symptoms. We defined a binary outcome: modified Rankin Scale (mRS) ≤ 3 = good outcome versus mRS > 3 = poor outcome at discharge. The predictive value of each sign was assessed in uni- and multivariable logistic regression models. Results: Of 129 patients with ICH under ORAC, 76 (58.9%) presented with hypodensities within the hematoma in admission NCCT, 64 (52.7%) presented with an irregular shape of the hematoma, 60 (46.5%) presented with a swirl sign, 49 (38.0%) presented with a black hole sign, and 46 (35.7%) presented with a heterogeneous density of the hematoma. Moreover, 44 (34.1%) patients had a satellite sign, in 20 (15.5%) patients, an island sign was detected, 18 (14.0%) patients were blend-sign positive, and 14 (10.9%) patients presented with a CTA spot sign. Inter-rater agreement was very high for all included characteristics between the two readers. Multivariable logistic regression analysis identified the presence of black hole sign (odds ratio 10.59; p < 0.001), swirl sign (odds ratio 14.06; p < 0.001), and satellite sign (odds ratio 6.38; p = 0.011) as independent predictors of poor outcome. Conclusions: The distribution and prognostic value of several NCCT markers and CTA spot sign in ICH patients under ORAC is comparable to those with spontaneous ICH, even though these parameters are partly based on coagulant status. These findings suggest that a similar approach can be used for further research regarding outcome prediction in ICH patients under ORAC and those with spontaneous ICH.

scholarly journals Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients

Stroke ◽  
2016 ◽  
Vol 47 (10) ◽  
pp. 2511-2516 ◽  
Author(s):  
Gregoire Boulouis ◽  
Andrea Morotti ◽  
H. Bart Brouwers ◽  
Andreas Charidimou ◽  
Michael J. Jessel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Poor Outcome ◽  
Noncontrast Computed Tomography

scholarly journals External Validation of the Secondary Intracerebral Hemorrhage Score in The Netherlands

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2904-2906 ◽  
Author(s):  
Charlotte J.J. van Asch ◽  
Birgitta K. Velthuis ◽  
Jacoba P. Greving ◽  
Peter Jan van Laar ◽  
Gabriël J.E. Rinkel ◽  
...  
Keyword(s):  
United States ◽  
Computed Tomography ◽  
The Netherlands ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
The United States ◽  
Pathological Examination ◽  
Discriminative Ability ◽  
Ich Score ◽  
Noncontrast Computed Tomography

Background and Purpose— We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH. Methods— Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause). Results— Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration ( P =0.06) and modest discriminative ability ( c -statistic 0.73; 95% confidence interval, 0.65–0.80). Discrimination improved slightly using only noncontrast computed tomography categorization ( c -statistic 0.79; 95% confidence interval, 0.72–0.86). Conclusions— The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.

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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