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European Radiology
Erschienen in: European Radiology 7/2013

01.07.2013 | Computed Tomography

“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage

verfasst von: Sheng-Jun Sun, Pei-Yi Gao, Bin-Bin Sui, Xin-Yi Hou, Yan Lin, Jing Xue, Ren-You Zhai

Erschienen in: European Radiology | Ausgabe 7/2013

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Abstract

Objectives

To evaluate the association between dynamic progressive enhancing foci (“dynamic spot sign”) in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion.

Methods

One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed.

Results

Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386–590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123–1295.488), P < 0.0001.

Conclusions

The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign.

Key Points

• It is important to identify potential progression of spontaneous intracerebral haemorrhage.
• Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion.
• The CTP dynamic spot sign may be present throughout arterial to venous phase imaging.
• The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.
Literatur
1.
Broderick JP, Adams HP Jr, Barsan W et al (1999) Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30:905–915PubMedCrossRef
2.
Broderick JP, Brott T, Tomsick T et al (1992) The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med 326:733–736PubMedCrossRef
3.
Broderick JP, Brott TG, Duldner JE et al (1993) Volume of intracerebral hemorrhage: a powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993PubMedCrossRef
4.
Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC (2001) The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32:891–897PubMedCrossRef
5.
Leira R, Davalos A, Silva Y et al (2004) Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 10:461–467CrossRef
6.
Davis SM, Broderick J, Hennerici M et al (2006) Recombinant activated factor VII intracerebral hemorrhage trial investigators. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 66:1175–1181PubMedCrossRef
7.
NINDS ICH Workshop Participants (2005) Priorities for clinical research in intracerebral hemorrhage: report from a National Institute of Neurological Disorders and Stroke workshop. Stroke 36:23–41.
8.
Mayer SA, Rincon F (2006) Ultra-early hemostatic therapy for acute intracerebral hemorrhage. Semin Hematol 43:S70–S76PubMedCrossRef
9.
Mayer SA, Brun NC, Begtrup K et al (2005) Recombinant activated factor VII intracerebral hemorrhage trial investigators. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:777–785PubMedCrossRef
10.
Flibotte JJ, Hagan N, O’Donnell J et al (2004) Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology 63:1059–1064PubMedCrossRef
11.
Flaherty ML, Woo D, Haverbusch M et al (2005) Potential applicability of recombinant factor VIIa for intracerebral hemorrhage. Stroke 36:2660–2664PubMedCrossRef
12.
Yasui T, Kishi H, Komiyama M et al (1996) Very poor prognosis in cases with extravasation of the contrast medium during angiography. Surg Neurol 45:560–565PubMedCrossRef
13.
Murai Y, Ikeda Y, Teramoto A et al (1998) Magnetic resonance imaging documented extravasation as an indicator of acute hypertensive intracerebral hemorrhage. J Neurosurg 88:650–655PubMedCrossRef
14.
Walker MT, Wattamwar A, Mellman D et al (2005) Active hemorrhage into a postresection cavity detected by neuro-CT angiography. AJNR Am J Neuroradiol 26:1163–1165PubMed
15.
Becker KJ, Baxter AB, Bybee HM et al (1999) Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral. Stroke 30:2025–2032PubMedCrossRef
16.
Brouwers HB, Falcone GJ, McNamara KA et al (2012) CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage. Neurocrit Care 17:421–428PubMedCrossRef
17.
Romero JM, Heit JJ, Delgado Almandoz JE et al (2012) Spot sign score predicts rapid bleeding in spontaneous intracerebral hemorrhage. Emerg Radiol 19:195–202PubMedCrossRef
18.
Wada R, Aviv RI, Fox AJ et al (2007) CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 38:1257–1262PubMedCrossRef
19.
Demchuk AM, Dowlatshahi D, Rodriguez-Luna D et al (2012) Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol 11:307–314PubMedCrossRef
20.
d’Esterre CD, Chia TL, Jairath A et al (2011) Early rate of contrast extravasation in patients with intracerebral hemorrhage. AJNR Am J Neuroradiol 32:1879–1884PubMedCrossRef
21.
Kothari RU, Brott T, Broderick JP et al (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305PubMedCrossRef
22.
Ohwaki K, Yano E, Nagashima H et al (2004) Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke 35:1364–1367PubMedCrossRef
23.
Toyoda K, Okada Y, Minematsu K et al (2005) Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology 65:1000–1004PubMedCrossRef
24.
Fisher CM (1971) Pathological observations in hypertensive cerebral hemorrhage. J Neuropathol Exp Neurol 30:536–550PubMedCrossRef
25.
Huynh TJ, Keith J, Aviv RI (2012) Histopathological characteristics of the “spot sign” in spontaneous intracerebral hemorrhage. Arch Neurol 24:1–2
26.
Ederies A, Demchuk A, Chia T et al (2009) Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke 40:1672–1676PubMedCrossRef
27.
Almandoz JE, Yoo AJ, Stone MJ et al (2009) Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score. Stroke 40:2994–3000CrossRef
28.
Kim J, Smith A, Hemphill JC et al (2008) Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. AJNR Am J Neuroradiol 29:520–525PubMedCrossRef
29.
Hoh BL, Cheung AC, Rabinov JD et al (2004) Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 54:1329–1340PubMedCrossRef
30.
Sanelli PC, Mifsud MJ, Stieg PE (2004) Role of CT angiography in guiding management decisions of newly diagnosed and residual arteriovenous malformations. AJR Am J Roentgenol 183:1123–1126PubMedCrossRef
31.
Fainardi E, Borrelli M, Saletti A et al (2008) CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage. Neuroradiology 50:729–740PubMedCrossRef
32.
33.
Xi G, Keep RF, Hoff JT (2006) Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neuro 15:53–63CrossRef
Metadaten
Titel
“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage
verfasst von
Sheng-Jun Sun
Pei-Yi Gao
Bin-Bin Sui
Xin-Yi Hou
Yan Lin
Jing Xue
Ren-You Zhai
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 7/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2803-4

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