title: CT angiography spot sign predicts in-hospital mortality in patients with secondary intracerebral hemorrhage.
abstract: OBJECTIVE
  The presence of active contrast extravasation during CT angiography, the spot sign, is a potent predictor of in-hospital mortality in patients with primary intracerebral hemorrhage (ICH). However, its predictive value in patients with ICH due to a vascular abnormality, secondary ICH (SICH), is unknown. The aim of this study was to determine the clinical and radiological predictors of a spot sign and in-hospital mortality in patients with SICH.
  
  
  METHODS
  Two experienced readers independently reviewed CT angiograms performed on 215 consecutive patients presenting to the emergency department with SICH over a 10-year period to assess the presence of spot signs according to strict radiological criteria. Differences in reader interpretation were resolved by consensus. Medical records were reviewed for baseline clinical characteristics and in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to determine the clinical and radiological predictors of a spot sign and in-hospital mortality in patients with SICH.
  
  
  RESULTS
  Spot signs were identified in 31 of 215 patients with SICH (14.4%), four of which were delayed spot signs (12.9%). Spot signs were most common in patients with arteriovenous fistulas (42%), Moyamoya (40%), elevated admission blood glucose (23%) and large intraventricular hemorrhage volumes (29%). Spot signs were most predictive of in-hospital mortality in patients with aneurysms of the anterior cerebral artery (100%) and anterior communicating artery (75%). In univariate analysis, the presence of a spot sign significantly increased the risk of in-hospital mortality in patients with SICH (38.7%, OR 2.2, 95% CI 1.0 to 4.9, p=0.0497). However, in multivariate logistic regression analysis the admission Glasgow Coma Scale was the only independent predictor of in-hospital mortality in patients with SICH (OR 2.8, 95% CI 1.6 to 5.1, p=0.0004).
  
  
  CONCLUSIONS
  The spot sign identifies patients with SICH at increased risk of in-hospital mortality. However, the admission Glasgow Coma Scale was the only independent predictor of in-hospital mortality in this cohort of patients with SICH.
authors: Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA. josser.delgado@crlmed.com
authors: Josser E
authors: JE
authors: Delgado Almandoz
authors: Hillary R
authors: HR
authors: Kelly
authors: Pamela W
authors: PW
authors: Schaefer
authors: H Bart
authors: HB
authors: Brouwers
authors: Albert J
authors: AJ
authors: Yoo
authors: Michael J
authors: MJ
authors: Stone
authors: Joshua N
authors: JN
authors: Goldstein
authors: Jonathan
authors: J
authors: Rosand
authors: Michael H
authors: MH
authors: Lev
authors: R Gilberto
authors: RG
authors: Gonzalez
authors: Javier M
authors: JM
authors: Romero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods / Q000592:standards; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality*; D002648:Child; D015331:Cohort Studies; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*; D055815:Young Adult