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. 2014 Nov;45(11):3293-7.
doi: 10.1161/STROKEAHA.114.005570. Epub 2014 Oct 9.

Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study

Viesha A Ciura  1 , H Bart Brouwers  1 , Raffaella Pizzolato  1 , Claudia J Ortiz  1 , Jonathan Rosand  1 , Joshua N Goldstein  1 , Steven M Greenberg  1 , Stuart R Pomerantz  1 , R Gilberto Gonzalez  1 , Javier M Romero  2
Affiliations

Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study

Viesha A Ciura et al. Stroke. 2014 Nov.

Abstract

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.

Keywords: cerebral hemorrhage; computed tomography angiography; mortality.

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