scholarly journals Dual-Energy CT Angiography Improves Accuracy of Spot Sign for Predicting Hematoma Expansion in Intracerebral Hemorrhage

2021 ◽  
Vol 23 (1) ◽  
pp. 82-90
Author(s):  
Michaël T.J. Peeters ◽  
Kim J.D. de Kort ◽  
Rik Houben ◽  
Wouter J.P. Henneman ◽  
Robert J. van Oostenbrugge ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Dual Energy ◽  
Hematoma Expansion ◽  
Dual Energy Ct ◽  
Spot Sign ◽  
Poor Outcome ◽  
Fusion Images ◽  
Delayed Phase

Background and Purpose Spot sign (SS) on computed tomography angiography (CTA) is associated with hematoma expansion (HE) and poor outcome after intracerebral hemorrhage (ICH). However, its predictive performance varies across studies, possibly because differentiating hyperdense hemorrhage from contrast media is difficult. We investigated whether dual-energy-CTA (DE-CTA), which can separate hemorrhage from iodinated contrast, improves the diagnostic accuracy of SS for predicting HE.Methods Primary ICH patients undergoing DE-CTA (both arterial as well as delayed venous phase) and follow-up computed tomography were prospectively included between 2014 and 2019. SS was assessed on both arterial and delayed phase images of the different DE-CTA datasets, i.e., conventional-like mixed images, iodine images, and fusion images. Diagnostic accuracy of SS for prediction of HE was determined on all datasets. The association between SS and HE, and between SS and poor outcome (modified Rankin Scale at 3 months ≥3) was assessed with multivariable logistic regression, using the dataset with highest diagnostic accuracy.Results Of 139 included patients, 47 showed HE (33.8%). Sensitivity of SS for HE was 32% (accuracy 0.72) on conventional-like mixed arterial images which increased to 76% (accuracy 0.80) on delayed fusion images. Presence of SS on delayed fusion images was independently associated with HE (odds ratio [OR], 17.5; 95% confidence interval [CI], 6.14 to 49.82) and poor outcome (OR, 3.84; 95% CI, 1.16 to 12.73).Conclusions Presence of SS on DE-CTA, in particular on delayed phase fusion images, demonstrates higher diagnostic performance in predicting HE compared to conventional-like mixed imaging, and it is associated with poor outcome.

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.

Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis

2021 ◽  
pp. 174749302110616
Author(s):  
Arba Francesco ◽  
Rinaldi Chiara ◽  
Boulouis Gregoire ◽  
Fainardi Enrico ◽  
Charidimou Andreas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Significant Risk ◽  
Irregular Shape ◽  
Hematoma Expansion ◽  
Logistic Regression Models ◽  
Noncontrast Computed Tomography

Background and purpose Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. Methods We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. Results A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20–0.47) for island sign to 0.68 (95%CI = 0.57–0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36–0.59) for irregular shape to 0.92 (95%CI = 0.85–0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21–0.35) for black hole sign to 0.63 (95%CI = 0.44–0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56–0.73) for heterogeneous density to 0.89 (95%CI = 0.85–0.92) for blend sign. Conclusion Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients’ selection for hematoma expansion targeted trials.

scholarly journals Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2883-2890 ◽  
Author(s):  
Sae-Yeon Won ◽  
Frieder Schlunk ◽  
Julien Dinkel ◽  
Hulya Karatas ◽  
Wendy Leung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Contrast Medium ◽  
Dual Energy ◽  
Hematoma Expansion ◽  
Prothrombin Complex Concentrates ◽  
Dual Energy Computed Tomography ◽  
Warfarin Group ◽  
Significant Difference ◽  
Contrast Medium Extravasation

Background and Purpose— Contrast medium extravasation (CE) in intracerebral hemorrhage (ICH) is a marker of ongoing bleeding and a predictor of hematoma expansion. The aims of the study were to establish an ICH model in which CE can be quantified, characterized in ICH during warfarin and dabigatran anticoagulation, and to evaluate effects of prothrombin complex concentrates on CE in warfarin-associated ICH. Methods— CD1-mice were pretreated orally with warfarin, dabigatran, or vehicle. Prothrombin complex concentrates were administered in a subgroup of warfarin-treated mice. ICH was induced by stereotactic injection of collagenase VIIs into the right striatum. Contrast agent (350 μL Isovue 370 mg/mL) was injected intravenously after ICH induction (2–3.5 hours). Thirty minutes later, mice were euthanized, and CE was measured by quantifying the iodine content in the hematoma using dual-energy computed tomography. Results— The optimal time point for contrast injection was found to be 3 hours after ICH induction, allowing detection of both an increase and a decrease of CE using dual-energy computed tomography. CE was higher in the warfarin group compared with the controls ( P =0.002). There was no significant difference in CE between dabigatran-treated mice and controls. CE was higher in the sham-treated warfarin group than in the prothrombin complex concentrates–treated warfarin group ( P <0.001). Conclusions— Dual-energy computed tomography allows quantifying CE, as a marker of ongoing bleeding, in a model of anticoagulation-associated ICH. Dabigatran induces less CE in ICH than warfarin and consequently reduces risks of hematoma expansion. This constitutes a potential safety advantage of dabigatran over warfarin. Nevertheless, in case of warfarin anticoagulation, prothrombin complex concentrates reduce this side effect.

scholarly journals Heterogeneity Signs on Noncontrast Computed Tomography Predict Hematoma Expansion after Intracerebral Hemorrhage: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Danfeng Zhang ◽  
Jigang Chen ◽  
Qiang Xue ◽  
Bingying Du ◽  
Ya Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Random Effects Model ◽  
Poor Outcome ◽  
Increased Risk ◽  
Noncontrast Computed Tomography ◽  
Swirl Sign

Background and Purpose. Hematoma expansion (HE) is related to clinical deterioration after intracerebral hemorrhage (ICH) and noncontrast computed tomography (NCCT) signs are indicated as predictors for HE but with inconsistent conclusions. We aim to clarify the correlations of NCCT heterogeneity signs with HE by meta-analysis of related studies. Methods. PubMed, Embase, and Cochrane library were searched for eligible studies exploring the relationships between NCCT heterogeneity signs (hypodensity, mixed density, swirl sign, blend sign, and black hole sign) and HE. Poor outcome and mortality were considered as secondary outcomes. Odds ratio (OR) and its 95% confidence intervals (CIs) were selected as the effect size and combined using random effects model. Results. Fourteen studies were included, involving 3240 participants and 435 HEs. The summary results suggested statistically significant correlations of heterogeneity signs with HE (OR, 5.17; 95% CI, 3.72–7.19, P<0.001), poor outcome (OR, 3.60; 95% CI, 1.98–6.54, P<0.001), and mortality (OR, 4.64; 95%, 2.96–7.27, P<0.001). Conclusions. Our findings suggested that hematoma heterogeneity signs on NCCT were positively associated with the increased risk of HE, poor outcome, and mortality rate in ICH.

Quantitative assessment of local perfusion change in acute intracerebral hemorrhage areas with and without “dynamic spot sign” using CT perfusion imaging

2018 ◽  
Vol 60 (3) ◽  
pp. 367-373
Author(s):  
Fan Fu ◽  
Binbin Sui ◽  
Liping Liu ◽  
Yaping Su ◽  
Shengjun Sun ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Control Group ◽  
Regional Cerebral Blood ◽  
Spot Sign ◽  
Positive Group ◽  
Regional Cerebral Blood Volume ◽  
Acute Intracerebral Hemorrhage

Background Positive “dynamic spot sign” has been proven to be a potential risk factor for acute intracerebral hemorrhage (ICH) expansion, but local perfusion change has not been quantitatively investigated. Purpose To quantitatively evaluate perfusion changes at the ICH area using computed tomography perfusion (CTP) imaging. Material and Methods Fifty-three patients with spontaneous ICH were recruited. Unenhanced computed tomography (NCCT), CTP within 6 h, and follow-up NCCT were performed for 21 patients in the “spot sign”-positive group and 32 patients in the control group. Cerebral perfusion change was quantitatively measured on regional cerebral blood flow/regional cerebral blood volume (rCBF/rCBV) maps. Regions of interest (ROIs) were set at the “spot-sign” region and the whole hematoma area for “spot-sign”-positive cases, and at one of the highest values of three interested areas and the whole hematoma area for the control group. Hematoma expansion was determined by follow-up NCCT. Results For the “spot-sign”-positive group, the average rCBF (rCBV) values at the “spot-sign” region and the whole hematoma area were 21.34 ± 15.24 mL/min/100 g (21.64 ± 21.48 mL/100g) and 5.78 ± 6.32 mL/min/100 g (6.07 ± 5.45 mL/100g); for the control group, the average rCBF (rCBV) values at the interested area and whole hematoma area were 2.50 ± 1.83 mL/min/100 g (3.13 ± 1.96 mL/100g) and 3.02 ± 1.80 mL/min/100 g (3.40 ± 1.44 mL/100g), respectively. Average rCBF and rCBV values of the “spot-sign” region were significantly different from other regions ( P < 0.001; P = 0.004). The average volumes of hematoma expansion in the “spot-sign”-positive and control groups were 25.24 ± 19.38 mL and −0.41 ± 1.34 mL, respectively. Conclusion The higher perfusion change at ICH on CTP images may reflect the contrast extravasation and be associated with the hematoma expansion.

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

scholarly journals Hematoma Ventricle Distance on Computed Tomography Predicts Poor Outcome in Intracerebral Hemorrhage

2020 ◽  
Vol 14 ◽  
Author(s):  
Lan Deng ◽  
Yun-Dong Zhang ◽  
Jian-Wen Ji ◽  
Wen-Song Yang ◽  
Xiao Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Final Analysis ◽  
Hematoma Expansion ◽  
Youden Index ◽  
Multivariable Logistic Regression Analysis ◽  
Poor Outcome

ObjectiveTo investigate the relationship between hematoma ventricle distance (HVD) and clinical outcome in patients with intracerebral hemorrhage (ICH).MethodsWe prospectively enrolled consecutive patients with ICH in a tertiary academic hospital between July 2011 and April 2018. We retrospectively reviewed images for all patients receiving a computed tomography (CT) within 6 h after onset of symptoms and at least one follow-up CT scan within 36 h. The minimum distance of hematoma border to nearest ventricle was measured as HVD. Youden index was used to evaluate the cutoff of HVD predicting functional outcome. Logistic regression model was used to assess the HVD data and clinical poor outcome (modified Rankin Scale 4–6) at 90 days.ResultsA total of 325 patients were included in our final analysis. The median HVD was 2.4 mm (interquartile range, 0–5.7 mm), and 119 (36.6%) patients had poor functional outcome at 3 months. After adjusting for age, admission Glasgow coma scale, intraventricular hemorrhage, baseline ICH volume, admission systolic blood pressure, blood glucose, hematoma expansion, withdrawal of care, and hypertension, HVD ≤ 2.5 mm was associated with increased odds of clinical poor outcome [odd ratio, 3.59, (95%CI = 1.72–7.50); p = 0.001] in multivariable logistic regression analysis.ConclusionHematoma ventricle distance allows physicians to quickly select and stratify patients in clinical trials and thereby serve as a novel and useful addition to predict ICH prognosis.

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