The Role of digital subtraction angiography in the ventricular spot sign on the computed tomography angiography

OBJECTIVE: The spot sign on computed tomography angiography is little known about the relationship between the spot sign and the results of cerebral angiography We retrospectively analyzed the spot sign, digital subtraction angiography results, and other factors.MATERIAL AND METHODS: From December 2009 to May 2014, DSA was performed in 52 ICH patients with non-specific location or abnormalities on CTA findings. 26 of those patients, whose initial CTA showed the spot sign, were analyzed. Two groups, one with the spot sign in the ventricle (Group A) and others with the spot sign in another location (Group B) were statistically compared.RESULTS: The mean age of the study subjects was 46.9 years (range, 15 to 80 years) and the percentage of males was 53.8%. Thirteen of 26 patients had ICH without intraventricular hemorrhage, and 6 patients had co-existing IVH. In 17 cases, the DSA results were negative. Seven patients were diagnosed with pseudoaneurysms, and two cases showed developmental venous anomalies. Group A consisted of the 8 patients (30.8%) who showed the spot sign in a ventricle. The number of pseudoaneurysms was statistically significantly higher in Group A than in Group B (71.4% versus 28.6%; OR, 13.3; 95% CI, 1.7-103.8 P = 0.014). All three patients who underwent endovascular treatment were members of Group A (P = 0.022), whereas most (92.3%) of those in Group B underwent surgical evacuation. (P = 0.030).CONCLUSION: When CTA shows the spot sign in a ventricle, it is a clue that an existing underlying vascular lesion requires endovascular treatment.

Surgery versus Conservative Treatment for Spontaneous Supratentorial Intracerebral Hemorrhage in Spot Sign Positive Patients

OBJECTIVE: An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH. METHODS: We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume > or =20 mL, and treatment within 24 hours. RESULTS: Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group (7.36+/-3.66 days) and the surgical treatment group (6.93+/-2.20 days; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group (13.93+/-8.87 days) and the surgical treatment group (20.33+/-6.37 days; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up. CONCLUSION: In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.

Spot Sign on Initial Brain Computed Tomography Angiography Source Image to Predict Large Hemorrhagic Transformation after Middle Cerebral Artery Infarction

The spot sign refers to tiny enhanced foci within the hematoma on a brain computed tomography angiography image. A spot sign is usually considered to be associated with hematoma progression in patients with acute intracerebral hemorrhage. We describe a patient with infarction of the left middle cerebral artery where a spot sign was observed. A spot sign may also have significant predictive value for large hemorrhagic transformation in patients with ischemic stroke.

Clinical significance of CT-angiography spot sign in predicting hematoma enlargement in acute hypertensive cerebral hemorrhage / 实用医学杂志

Objective To explore the clinical significance of CT-angiography (CTA) in predicting hematoma enlargement in patients with acute hypertensive cerebral hemorrhage (HICH). Methods A prospective cohort study was performed on 50 patients with HICH. HICH and spot sign were diagnosed definitely by computerized tomography (CT) and CTA within 3 ~ 6 hours of symptom onset. Patients were dichotomized according to the presence or absence of the spot sign. CT scan was repeated immediately when patients′symptoms worsened or at 24 hours after onset of symptoms in order to find out the enlargement of hematomas. The relationship between hematoma expansion and spot sign of CTA was investigated. Results (1) Thirteen (26.0%) patients demonstrated the presence of spot sign of CTA, and 37 (74.0%) patients were without spot sign. Baseline clinical variables were similar in both groups. (2) Hematoma expansion occurred in 14 (28.0%) patients on follow-up. Eleven (84.6%) patients with and 3 (8.1%) patients without the spot sign of CTA were demonstrated hematoma expansion. The significance difference was found between the two groups (X2=24.27,P<0.05). Conclusions In acute HICH patients, CTA provided more radiological information and the CTA spot sign was associated with the presence of hematoma expansion. The spot sign will be recommended as an entry criterion for future trials of haemostatic therapy in patients with acute HICH.

Association Factors for CT Angiography Spot Sign and Hematoma Growth in Korean Patients with Acute Spontaneous Intracerebral Hemorrhage : A Single-Center Cohort Study

OBJECTIVE: This study was conducted to clarify the association factors and clinical significance of the CT angiography (CTA) spot sign and hematoma growth in Korean patients with acute intracerebral hemorrhage (ICH). METHODS: We retrospectively collected the data of 287 consecutive patients presenting with acute ICH who arrived within 12 hours of ictus. Baseline clinical and radiological characteristics as well as the mortality rate within one month were assessed. A binary logistic regression was conducted to obtain association factors for the CTA spot sign and hematoma growth. RESULTS: We identified a CTA spot sign in 40 patients (13.9%) and hematoma growth in 78 patients (27.2%). An elapsed time to CT scan of less than 3 hours (OR, 5.14; 95% CI, 1.76-15.02; p=0.003) was associated with the spot sign. A CTA spot sign (OR, 5.70; 95% CI, 2.70-12.01; p40 IU (OR, 2.01; 95% CI, 1.01-4.01; p=0.047), and an international normalized ratio > or =1.8 or warfarin medication (OR, 5.64; 95% CI, 1.29-24.57; p=0.021) were independent predictors for hematoma growth. Antiplatelet agent medication (OR, 4.92; 95% CI, 1.31-18.50; p=0.019) was significantly associated with hematoma growth within 6 hours of ictus. CONCLUSION: As previous other populations, CTA spot sign was a strong predictor for hematoma growth especially in hyper-acute stage of ICH in Korea. Antithrombotics medication might also be associated with hyper-acute hematoma growth. In our population, elevated GPT was newly identified as a predictor for hematoma growth and its effect for hematoma growth is necessary to be confirmed through a further research.

The Spot Sign Predicts Hematoma Expansion, Outcome, and Mortality in Patients with Primary Intracerebral Hemorrhage

OBJECTIVE: The purpose of this study was to retrospectively review cases of intracerebral hemorrhage (ICH) medically treated at our institution to determine if the CT angiography (CTA) 'spot sign' predicts in-hospital mortality and clinical outcome at 3 months in patients with spontaneous ICH. METHODS: We conducted a retrospective review of all consecutive patients who were admitted to the department of neurosurgery. Clinical data of patients with ICH were collected by 2 neurosurgeons blinded to the radiological data and at the 90-day follow-up. RESULTS: Multivariate logistic regression analysis identified predictors of poor outcome; we found that hematoma location, spot sign, and intraventricular hemorrhage were independent predictors of poor outcome. In-hospital mortality was 57.4% (35 of 61) in the CTA spot-sign positive group versus 7.9% (10 of 126) in the CTA spot-sign negative group. In multivariate logistic analysis, we found that presence of spot sign and presence of volume expansion were independent predictors for the in-hospital mortality of ICH. CONCLUSION: The spot sign is a strong independent predictor of hematoma expansion, mortality, and poor clinical outcome in primary ICH. In this study, we emphasized the importance of hematoma expansion as a therapeutic target in both clinical practice and research.

Which Emphasizing Factors Are Most Predictive of Hematoma Expansion in Spot Sign Positive Intracerebral Hemorrhage?

OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage / Extravasamento ativo de contraste no interior da hemorragia (spot sign): um achado de TCMD que prediz crescimento e pior prognostico nas hemorragias intraparenquimatosas cerebrais nao traumaticas

Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality. .

A hemorragia intraparenquimatosa cerebral (HIC) apresenta altas taxas de incapacidade e sequela neurológica. Objetivo Avaliar a presença de spot sign como preditor de expansão e pior prognóstico no follow-up de HIC não-traumática em brasileiros. Método Usamos a ângio-tomografia para estudar prospectivamente 65 pacientes consecutivos (40 homens 61,5%), com idades variando de 33 a 89 anos (mediana 55 anos). Evolução clínica e achados de imagem foram correlacionados com a interpretação dos achados do exame inicial. Resultados 73,7% dos indivíduos com spot sign no estudo tomográfico inicial evoluíram para óbito e, na sua ausência, a taxa de mortalidade foi 43,0%. Enquanto a expansão da HIC foi detectada em 75% dos pacientes com spot sign, ela foi notada em 9% daqueles sem este sinal. Conclusão O spot sign mostrou-se forte preditor de expansão da HIC não traumática e representa maior risco de morte hospitalar nesta coorte de pacientes. .