Hematoma Volume Affects the Accuracy of Computed Tomographic Angiography ‘Spot Sign’ in Predicting Hematoma Expansion after Acute Intracerebral Hemorrhage

Abstract

Background: We hypothesized that the presence of tiny, enhancing foci (‘spot sign’) within acute hematomas is associated with hematoma expansion. Methods: We retrospectively analyzed the effect of hematoma volume on accuracy of computed tomographic angiography (CTA) in predicting hematoma expansion in 312 patients with acute intracerebral hemorrhage (ICH). The patients were divided into 2 groups according to their initial hematoma volume (<30 vs. ≧30 ml). CTA was performed at admission and 24 h after initial presentation. Results: The <30-ml group consisted of 203 patients of whom 42 had hematoma expansion (20.9%). The ≧30-ml group consisted of 109 patients of whom 34 had hematoma expansion (31.19%). In the <30-ml group, the sensitivity and specificity of CTA in predicting hematoma expansion were 71.4 and 93.8%, respectively. In the ≧30-ml group, the sensitivity and specificity of CTA were 85.7 and 91.9%, respectively. For all 312 patients, the area under the curve was 0.86 (p < 0.001, 95% CI 0.80–0.92); the sensitivity and specificity of CTA were 77.9 and 93.2%, respectively. Conclusions: CTA can reliably predict hematoma expansion in clinical practice, especially for hematomas >30 ml.