Spot Sign Characteristics and Hematoma Expansion in Acute Intracerebral Hemorrhage
Tiffany Eatz1, Sebastian Koch2, Berje Shammassian3, Whitney Mayberry4, Alexis Alvarado Arias5, Amedeo Merenda6, Ayham Alkhachroum7
1University of Miami Miller School of Medicine, 2University of Miami, 3LSUHSC - New Orleans/University Medical Center, 4Jackson Memorial Hospital, 5University of Mississippi, 6Univeristy of Miami Miller School of Medicine, 7Columbia University Medical Center
Objective:
We investigated how features other than presence of computed tomography angiography (CTA) spot sign, such as spot sign location, number, intensity, and size, influence hematoma expansion in acute intracerebral hemorrhage (ICH).
Background:
In 1971, C. Miller Fisher described the concept of a spot sign, now considered a biomarker of ongoing bleeding and predictor of acute ICH expansion. However, a considerable number of patients with a spot sign do not experience expansion, which points to the possibility that other factors are involved in hemorrhagic growth. In the spirit of C.M. Fisher’s observations 50 years ago, we hypothesized that factors such as spot sign location, volume, and intensity may correlate with expansion.
Design/Methods:
We retrospectively reviewed clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a >33% increase in hematoma volume or >6ml increase in absolute hematoma volume between baseline and 24-hour follow-up brain CT. CTA images were examined for the presence of a spot sign. We studied the relationship between expansion and spot sign characteristics, including number, volume, and location (central versus peripheral).
Results:
CTA was obtained in 308 of 417 patients (73%). Hematoma expansion occurred in 72/308 (23%) cases, associated with increased age and spot sign presence. A spot sign was found in 39/308 (13%). Only spot sign volume was linked to expansion in univariate analysis (p = 0.04) and receiver operator analysis (area under the curve [AUC] = 0.68, p = 0.05). In multivariable modeling including age, spot sign location, volume, number, and Hounsfield unit, no independent predictors of expansion were found.
Conclusions:
We confirmed the influence of spot sign presence on hematoma expansion. Hematoma volume may be a more important predictor of growth than other spot sign features. We encourage further studies to potentially corroborate these findings.
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