Added value of delayed computed tomography angiography in primary intracranial hemorrhage and hematoma size for predicting spot sign

Abstract

Background The computed tomography angiography (CTA) spot sign represents active contrast extravasation within acute primary intracerebral hemorrhage (ICH) and is an independent predictor of hematoma expansion (HE) and poor clinical outcomes. The spot sign could be detected on first-pass CTA (fpCTA) or delayed CTA (dCTA). Purpose To investigate the additional benefits of dCTA spot sign in primary ICH and hematoma size for predicting spot sign. Material and Methods This is a retrospective study of 100 patients who underwent non-contrast CT (NCCT) and CTA within 24 h of onset of primary ICH. The presence of spot sign on fpCTA or dCTA, and hematoma size on NCCT were recorded. The spot sign on fpCTA or dCTA for predicting significant HE, in-hospital mortality, and poor clinical outcomes (mRS ≥ 4) are calculated. The hematoma size for prediction of CTA spot sign was also analyzed. Results Only the spot sign on dCTA could predict high risk of significant HE and poor clinical outcomes as on fpCTA ( P < 0.05). With dCTA, there is increased sensitivity and negative predictive value (NPV) for predicting significant HE, in-hospital mortality, and poor clinical outcomes. The XY value (product of the two maximum perpendicular axial dimensions) is the best predictor (area under the curve [AUC] = 0.82) for predicting spot sign on fpCTA or dCTA in the absence of intraventricular and subarachnoid hemorrhage. Conclusion This study clarifies that dCTA imaging could improve predictive performance of CTA in primary ICH. Furthermore, the XY value is the best predictor for CTA spot sign.

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

“…Delayed phase post-contrast CT acquisition have been shown to not only increase SS detection, but also improve the sensitivity of SS for predicting HE as well as outcome. 21,[27][28][29] Our results are in accordance to these findings with conventionallike mixed delayed phase images more often showing SS as well as having a higher sensitivity for HE when compared to conventional-like mixed arterial phase images. An additional increase in sensitivity, NPV, and accuracy of the SS for HE is seen when DE-CT iodine and fusion datasets are also assessed.…”

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings

“…The main diagnostic paradigms of CTA have so far only been focused on the binary analysis of positive vs negative bleeding signs as well as bleeding localization, while other potential predictive factors for future positive catheter angiography and resolutive TAE have been poorly explored[ 23 ]. Nevertheless, the volumetric assessment of bleeding or hematoma entity has been previously investigated in the literature.…”

“…Regarding GIB, in a series of three cases, P et al [ 38 ] described the potential of volumetric estimation of GIB on CTA for illustrative purposes rather than showing population-based results[ 38 ]. In another recent study exclusively focused on lower GIB[ 23 ], a similar semiautomatic dedicated software was adopted to determine the active hemorrhage size both with axial and volumetric measurements. Similarly to our series, this study obtained promising results, suggesting that such objective imaging characteristics detected at CTA may be successfully used to predict the likelihood of positive catheter angiography[ 23 ].…”

“…Furthermore, there is still debate on safety and utility of empiric embolization regardless of positive catheter angiography, primarily in lower GIB. In this regard, the GIB volumetric assessment enhances the role of CTA in improving patient selection and risk stratification, to better identify which patients would mostly benefit from (target or prophylactic) TAE, avoiding the adjunctive risks of an invasive procedure[ 23 , 38 ].…”

“…Volumetric analyses of arterial extravasation at CTA have been previously reported in several settings and through different softwares, with most of them applied to pelvic and intracranial districts[ 23 , 24 ].…”