Predicting Intracerebral Hemorrhage Growth With the Spot Sign Journal Articles uri icon

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  • Background and Purpose— Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign. Methods— We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates. Results— Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours ( P <0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased ( P =0.004), with positive predictive values decreasing from 53% to 33%. Conclusions— The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.


  • Dowlatshahi, Dar
  • Brouwers, H Bart
  • Demchuk, Andrew M
  • Hill, Michael D
  • Aviv, Richard I
  • Ufholz, Lee-Anne
  • Reaume, Michael
  • Wintermark, Max
  • Hemphill, J Claude
  • Murai, Yasuo
  • Wang, Yongjun
  • Zhao, Xingquan
  • Wang, Yilong
  • Li, Na
  • Sorimachi, Takatoshi
  • Matsumae, Mitsunori
  • Steiner, Thorsten
  • Rizos, Timolaos
  • Greenberg, Steven M
  • Romero, Javier M
  • Rosand, Jonathan
  • Goldstein, Joshua N
  • Sharma, Mukul

publication date

  • March 2016

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