Evolution of Computed Tomography Angiography Spot Sign Is Consistent With a Site of Active Hemorrhage in Acute Intracerebral Hemorrhage

Abstract

Background and Purpose-CT angiography spot sign predicts hematoma expansion in patients with acute intracerebral hemorrhage (ICH). The spot sign may represent a site of active extravasation, a locus of arrested hemorrhage forming fibrin globes, or represent associated epiphenomena such as hypertensive microaneurysms. We sought to describe the evolution of spot signs over 60 seconds in acute ICH using dynamic CT angiography and determine whether they grow and diffuse into the hematoma as would be expected with active extravasation. Methods-We prospectively identified consecutive patients presenting with spontaneous ICH <6 hours from symptom onset that completed dynamic CT angiography imaging over a 60-second acquisition protocol. We determined spot positivity, quantified spot volumes, and then used repeated-measures ANOVA to assess changes in spot volume over time. Results-We collected data on 35 patients; 13 of 35 (37%) patients were spot-positive. Spot-positive patients had larger median ICH volume compared with spot-negative patients (median 10.7 versus 49.2 mL; P=0.007). Maximal spot sign volumes ranged from 0.02 to 2.8 mL (median 0.17 mL). Spot sign volumes increased significantly with time (P<0.001) and seemed to disperse into the hematoma in all cases. Three of 13 (23%) spot-positive patients presented with 2 distinct spot signs, but the remaining patients either had only 1 spot sign or different contiguous components of an irregularly shaped spot sign. Conclusions-In

Ultraearly hematoma growth in active intracerebral hemorrhage

“…8 The spot sign was used as marker of active hemorrhage. [2][3][4][5][6] Outcomes. The primary outcome parameter was significant hematoma expansion at 24-hour CT defined as ICH relative enlargement of more than 33% or absolute growth greater than 6 mL from baseline CT. 4 The rate of hematoma expansion, defined as the difference between baseline and 24-hour ICH volume (mL) divided by baseline to 24-hour CT time (hours), 9 was evaluated as a secondary outcome.…”

“…By 2-hour intervals from symptoms onset, the uHG was higher the earlier the patients were .5] mL/h, p , 0.001), respectively. Baseline NIHSS score was higher in patients scanned earlier (15 [8][9][10][11][12][13][14][15][16][17][18][19], 13 [7][8][9][10][11][12][13][14][15][16][17], and 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], respectively, p 5 0.042), while other baseline characteristics were not related to onset to baseline CT time (p $ 0.050 for all comparisons, data not shown). Table 2 Intracerebral hemorrhage (ICH) volume, ultraearly hematoma growth (uHG), and CT angiography (CTA) spot sign by 2-hour intervals of time from symptoms onset to baseline CT scan uHG The simultaneous maximum sensitivity and specificity for uHG in predicting the primary outcome was 4.7 mL/h and for baseline ICH volume 10 mL.…”

“…[2][3][4][5][6] This is why 3 ongoing hemostatic clinical trials stratify patients according to the presence of a CTA spot sign, including Spot Sign Selection of Table 4 Sensitivity, specificity, predictive values, and area under the curve of intracerebral hemorrhage (ICH) volume, ultraearly hematoma growth (uHG), and the CT angiography (CTA) spot sign in the prediction of outcomes Intracerebral Hemorrhage to Guide Hemostatic Therapy (SPOTLIGHT, NCT01359202), the Spot Sign for Predicting and Treating ICH Growth Study (STOP-IT, NCT00810888), and the Spot Sign and Tranexamic Acid on Preventing ICH Growth-Australasia Trial (STOP-AUST). 13 In the present study, patients with the spot sign presented higher uHG than those without.…”

“…[2][3][4][5][6] Our previous study suggested that patients with the spot sign present higher uHG than those without. 1 We hypothesized that patients with higher uHG have higher spot sign prevalence and are more likely to expand and to present poorer outcomes than those with lower uHG.…”

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

“…An imbalance of the immune system involving the NLR can be used as a biomarker for a systematic inflammatory response. In addition, it is used to predict the prognosis of patients with various cancers [10,11], cardiovascular diseases [12,13] and hemorrhagic stroke [14][15][16]. Recently, NLR was used to predict in-hospital mortality [17,18], 90-day mortality [19][20][21] and 90-day poor outcomes (mRS≥3) [4,[21][22][23] in patients with ischemic stroke.…”