title: Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients.
abstract: OBJECTIVE
  The purpose of this study was to assess the effect of postcontrast CT (PCCT) leakage (PCL) on hematoma growth in CTA spot negative patients.
  
  
  METHODS
  A retrospective study of 61 patients presenting within 6 hours of primary ICH onset imaged with CT angiography (CTA) and PCCT. Presence of CTA spot sign and PCL were documented. PCL was defined as the presence of contrast extravasation on the PCCT study at a location remote from the CTA spot sign if present. Hematoma expansion was defined as >6 mL or 30% hematoma enlargement. Patients were dichotomized by CTA spot sign presence and PCL and compared for baseline demographic data, hematoma size, and growth using the unpaired t test and Mann-Whitney test for continuous and categorical data, respectively. A probability value <0.05 was considered significant.
  
  
  RESULTS
  PCL was present in 11/61 patients (18%), occurring in 5 without a spot sign (45%). Spot negative PCL patients demonstrated larger absolute (P=0.02) and percentage hematoma growth (P=0.02) compared to those without PCL. The mean volume and percent increase was 6.7 mL and 26%, respectively. Inclusion of PCL together with CTA spot sign as risk factor for hematoma expansion increased sensitivity from 0.78 (95% CI; 0.52 to 0.94) to 0.94 (95% CI; 0.72 to 1.00) and NPV from 0.90 (95% CI; 0.76 to 0.97) to 0.97 (95% CI; 0.85 to 1.00).
  
  
  CONCLUSIONS
  Inclusion of PCCT in the investigation of ICH patients allows detection of PCL which, together with the CTA spot sign, increases sensitivity and negative predictive value for predicting hematoma expansion. This finding should be validated in larger studies.
authors.affiliation: Department of Medical Imaging, Division of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Ederies
authors.forename: Andrew
authors.initials: A
authors.lastname: Demchuk
authors.forename: Tze
authors.initials: T
authors.lastname: Chia
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bendavit
authors.forename: Kelly
authors.initials: K
authors.lastname: Wong
authors.forename: Sean P
authors.initials: SP
authors.lastname: Symons
authors.forename: Richard I
authors.initials: RI
authors.lastname: Aviv
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000473:pathology*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*