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

Overview

Journal J Korean Neurosurg Soc

Date 2014 Oct 21

PMID 25328643

Citations 7

Authors

So Hyun Kim

Hyun Ho Jung

Kum Whang

Jong Yun Kim

Jin Su Pyen

Ji Woong Oh

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Dual-Energy CT Angiography Improves Accuracy of Spot Sign for Predicting Hematoma Expansion in Intracerebral Hemorrhage.

Peeters M, Kort K, Houben R, Henneman W, van Oostenbrugge R, Staals J J Stroke. 2021; 23(1):82-90.

PMID: 33600705 PMC: 7900388. DOI: 10.5853/jos.2020.03531.

Location of intracerebral haemorrhage predicts haematoma expansion.

Yogendrakumar V, Demchuk A, Aviv R, Rodriguez-Luna D, Molina C, Blas Y Eur Stroke J. 2019; 2(3):257-263.

PMID: 31008319 PMC: 6454825. DOI: 10.1177/2396987317715836.

Accuracy of spot sign in predicting hematoma expansion and clinical outcome: A meta-analysis.

Xu X, Zhang J, Yang K, Wang Q, Xu B, Chen X Medicine (Baltimore). 2018; 97(34):e11945.

PMID: 30142815 PMC: 6113011. DOI: 10.1097/MD.0000000000011945.

Predictors of hematoma expansion predictors after intracerebral hemorrhage.

Chen S, Zhao B, Wang W, Shi L, Reis C, Zhang J Oncotarget. 2017; 8(51):89348-89363.

PMID: 29179524 PMC: 5687694. DOI: 10.18632/oncotarget.19366.

Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients.

Peng W, Reis C, Reis H, Zhang J, Yang J Biomed Res Int. 2017; 2017:4137210.

PMID: 28852647 PMC: 5567448. DOI: 10.1155/2017/4137210.

References

Brouwers H, Chang Y, Falcone G, Cai X, Ayres A, Battey T . Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2013; 71(2):158-64. PMC: 4131760. DOI: 10.1001/jamaneurol.2013.5433. View

Brouwers H, Greenberg S . Hematoma expansion following acute intracerebral hemorrhage. Cerebrovasc Dis. 2013; 35(3):195-201. PMC: 3743539. DOI: 10.1159/000346599. View

Broderick J, Diringer M, Hill M, Brun N, Mayer S, Steiner T . Determinants of intracerebral hemorrhage growth: an exploratory analysis. Stroke. 2007; 38(3):1072-5. DOI: 10.1161/01.STR.0000258078.35316.30. View

Huttner H, Schellinger P, Hartmann M, Kohrmann M, Juettler E, Wikner J . Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex.... Stroke. 2006; 37(6):1465-70. DOI: 10.1161/01.STR.0000221786.81354.d6. View

Broderick J, Brott T, Tomsick T, Barsan W, Spilker J . Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg. 1990; 72(2):195-9. DOI: 10.3171/jns.1990.72.2.0195. View

Huynh T, Flaherty M, Gladstone D, Broderick J, Demchuk A, Dowlatshahi D . Multicenter accuracy and interobserver agreement of spot sign identification in acute intracerebral hemorrhage. Stroke. 2013; 45(1):107-12. DOI: 10.1161/STROKEAHA.113.002502. View

Huynh T, Demchuk A, Dowlatshahi D, Gladstone D, Krischek O, Kiss A . Spot sign number is the most important spot sign characteristic for predicting hematoma expansion using first-pass computed tomography angiography: analysis from the PREDICT study. Stroke. 2013; 44(4):972-7. DOI: 10.1161/STROKEAHA.111.000410. View

Wada R, Aviv R, Fox A, Sahlas D, Gladstone D, Tomlinson G . CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007; 38(4):1257-62. DOI: 10.1161/01.STR.0000259633.59404.f3. View

Wartenberg K, Mayer S . Reducing the risk of ICH enlargement. J Neurol Sci. 2007; 261(1-2):99-107. DOI: 10.1016/j.jns.2007.04.044. View

10.

Qureshi A, Mendelow A, Hanley D . Intracerebral haemorrhage. Lancet. 2009; 373(9675):1632-44. PMC: 3138486. DOI: 10.1016/S0140-6736(09)60371-8. View

11.

Delgado Almandoz J, Yoo A, Stone M, Schaefer P, Goldstein J, Rosand J . 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. 2009; 40(9):2994-3000. PMC: 3498504. DOI: 10.1161/STROKEAHA.109.554667. View

12.

Davis S, Broderick J, Hennerici M, Brun N, Diringer M, Mayer S . Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006; 66(8):1175-81. DOI: 10.1212/01.wnl.0000208408.98482.99. View

13.

Mayer S . Ultra-early hemostatic therapy for primary intracerebral hemorrhage: a review. Can J Neurol Sci. 2006; 32 Suppl 2:S31-7. View

14.

Huttner H, Steiner T, Hartmann M, Kohrmann M, Juettler E, Mueller S . Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke. 2005; 37(2):404-8. DOI: 10.1161/01.STR.0000198806.67472.5c. View

15.

Rodriguez-Yanez M, Castellanos M, Freijo M, Lopez Fernandez J, Marti-Fabregas J, Nombela F . Clinical practice guidelines in intracerebral haemorrhage. Neurologia. 2011; 28(4):236-49. DOI: 10.1016/j.nrl.2011.03.010. View

16.

Skidmore C, Andrefsky J . Spontaneous intracerebral hemorrhage: epidemiology, pathophysiology, and medical management. Neurosurg Clin N Am. 2002; 13(3):281-8, v. DOI: 10.1016/s1042-3680(02)00019-0. View

17.

Park S, Kong M, Kim J, Kang D, Song K, Huh S . Role of 'Spot Sign' on CT Angiography to Predict Hematoma Expansion in Spontaneous Intracerebral Hemorrhage. J Korean Neurosurg Soc. 2011; 48(5):399-405. PMC: 3030078. DOI: 10.3340/jkns.2010.48.5.399. View

18.

Gazzola S, Aviv R, Gladstone D, Mallia G, Li V, Fox A . Vascular and nonvascular mimics of the CT angiography "spot sign" in patients with secondary intracerebral hemorrhage. Stroke. 2008; 39(4):1177-83. DOI: 10.1161/STROKEAHA.107.499442. View

19.

Sun S, Gao P, Sui B, Hou X, Lin Y, Xue J . "Dynamic spot sign" on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage. Eur Radiol. 2013; 23(7):1846-54. DOI: 10.1007/s00330-013-2803-4. View

20.

Ederies A, Demchuk A, Chia T, Gladstone D, Dowlatshahi D, Bendavit G . Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke. 2009; 40(5):1672-6. DOI: 10.1161/STROKEAHA.108.541201. View