J Korean Neurosurg Soc.  2014 Oct;56(4):303-309. 10.3340/jkns.2014.56.4.303.

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

• Han JH
• Lee JM
• Koh EJ
• Choi HY

• KMID: 2018080
• DOI: http://doi.org/10.3340/jkns.2014.56.4.303

Abstract

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.

Keyword

Intracerebral hemorrhage; Spot sign; Outcome; Mortality

MeSH Terms

Angiography
Cerebral Hemorrhage*
Follow-Up Studies
Hematoma*
Hemorrhage
Hospital Mortality
Humans
Logistic Models
Mortality*
Neurosurgery
Retrospective Studies

Figure

• 

  Fig. 1 The appearance of a spot sign on CT angiography in a patient with intracerebral hemorrhage. The spot sign (black arrow) assesses diameter and Hounsfield units. The spot sign is located within the hematoma, has no connection to any outside vessel, and is absent on baseline non-contrast CT.

• 

  Fig. 2 A : A 61-year-old man underwent imaging 2 hours following onset of left-sided paralysis. NCCT demonstrates a right basal ganglia ICH (34 mL) with associated IVH (19 mL). B : Axial CTA source image in spot windows demonstrates 1 foci of contrast pooling within the ICH with an attenuation 176 HU (arrowheads), consistent with spot signs (a total of 4 spot signs were identified). The largest spot sign measured 5.7 mm in maximum axial dimension and had an attenuation of 245 HU (spot sign score, 4). C : Axial CTA image shows that the spot sign looks like aneurysmal sac. D : Non-contrast CT 4 hours after the baseline CTA demonstrates marked interval expansion of both the ICH (86 mL) and IVH (42 mL). E : Conventional angiographic image demonstrates absence of aneurysmal sac. NCCT : noncontrast CT, ICH : intracerebral hemorrhage, IVH : intraventricular hemorrhage, CTA : CT angiography, HU : Hounsfield units.

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