Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study.
BACKGROUND AND PURPOSE
The computed tomography angiography (CTA) spot sign is a validated biomarker for poor outcome and hematoma expansion in intracerebral hemorrhage. The spot sign has proven to be a dynamic entity, with multimodal imaging proving to be of additional value. We investigated whether the addition of a 90-second delayed CTA acquisition would capture additional intracerebral hemorrhage patients with the spot sign and increase the sensitivity of the spot sign.


METHODS
We prospectively enrolled consecutive intracerebral hemorrhage patients undergoing first pass and 90-second delayed CTA for 18 months at a single academic center. Univariate and multivariate logistic regression were performed to assess clinical and neuroimaging covariates for relationship with hematoma expansion and mortality.


RESULTS
Sensitivity of the spot sign for hematoma expansion on first pass CTA was 55%, which increased to 64% if the spot sign was present on either CTA acquisition. In multivariate analysis the spot sign presence was associated with significant hematoma expansion: odds ratio, 17.7 (95% confidence interval, 3.7-84.2; P=0.0004), 8.3 (95% confidence interval, 2.0-33.4; P=0.004), and 12.0 (95% confidence interval, 2.9-50.5; P=0.0008) if present on first pass, delayed, or either CTA acquisition, respectively. Spot sign presence on either acquisitions was also significant for mortality.


CONCLUSIONS
We demonstrate improved sensitivity for predicting hematoma expansion and poor outcome by adding a 90-second delayed CTA, which may enhance selection of patients who may benefit from hemostatic therapy.
['Ciura|Viesha A|VA|', 'Brouwers|H Bart|HB|', 'Pizzolato|Raffaella|R|', 'Ortiz|Claudia J|CJ|', 'Rosand|Jonathan|J|', 'Goldstein|Joshua N|JN|', 'Greenberg|Steven M|SM|', 'Pomerantz|Stuart R|SR|', 'Gonzalez|R Gilberto|RG|', 'Romero|Javier M|JM|']
D000368:Aged D000369:Aged, 80 and over D002543:Cerebral Hemorrhage D005260:Female D005500:Follow-Up Studies D006406:Hematoma D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D013997:Time Factors D014057:Tomography, X-Ray Computed
computed tomography angiography mortality cerebral hemorrhage