Abstract
Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage and leads to high rates of mortality and morbidity. Currently, contrast extravasation within hematoma, termed the spot sign on computed tomography angiography (CTA), has been identified as a strong independent predictor of early hematoma expansion. Past studies indicate that the spot sign is a dynamic entity and is indicative of active hemorrhage. Furthermore, to enhance the spot sign's accuracy of predicting HE, spot parameters observed on CTA or dynamic CTA were used for its quantification. In addition, spot signs detected on multiphase CTA and dynamic CTA are shown to have higher sensitivity and specificity when compared with simple standardized spot sign detection in recent studies. Based on the spot sign, novel methods such as leakage sign and rate of contrast extravasation were explored to redefine HE prediction in combination with clinical characteristics and spot sign on CTA to assist clinical judgment. The spot sign is an accepted independent predictor of active hemorrhage and is used in both secondary intracerebral hemorrhage and the process of surgical assessment for hemorrhagic risk in patients with ischemic stroke. Spot sign predicts patients at high risk for hematoma expansion.
Highlights
Spontaneous intracerebral hemorrhage (ICH) accounts anywhere from 10% to 50% of overall acute strokes depending on the population, race, and region being studied
This sign originated from the understanding that hematoma heterogeneity is closely related to early hematoma expansion (HE) and a subsequent original investigation identified hypodensities within an acute ICH detected on CT associated with HE
T1 weighted images have the same intensity as cerebral parenchyma in hyperacute stages of hematoma; it has a lower detection rate compared with computed tomography angiography (CTA) [45]
Summary
Spontaneous intracerebral hemorrhage (ICH) accounts anywhere from 10% to 50% of overall acute strokes depending on the population, race, and region being studied. 6 studies satisfied inclusion criteria that all spontaneous ICH patients were evaluated by CTA, received a follow-up CT, and reported clinical outcome accuracy measures of spot sign in predicting HE. In addition to CTA, imaging tools including magnetic resonance imaging (MRI), computed tomography perfusion (CTP), and contrast-enhanced CT are being explored for their use in detecting spot-like signs. These trials will be helpful in evaluating clinical prognosis using spot sign as diagnostic criteria, as well as providing evidence and future directions for ICH studies
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