title: 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.
abstract: OBJECTIVE
  The spot sign score (SSS) provides risk stratification for hematoma expansion in acute intracerebral hemorrhage; however, external validation is needed. We sought to validate the SSS and assess prognostic performance of individual spot characteristics associated with hematoma expansion from a prospective multicenter intracerebral hemorrhage study.
  
  
  METHODS
  Two hundred twenty-eight intracerebral hemorrhage patients within 6 hours after ictus were enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study, a multicenter prospective intracerebral hemorrhage cohort study. Patients were evaluated with baseline noncontrast computerized tomography, computerized tomography angiography, and 24-hour follow-up computerized tomography. Primary outcome was significant hematoma expansion (>6 mL or >33%) and secondary outcome was absolute and relative expansion. Blinded computerized tomography angiography spot sign characterization and SSS calculation were independently performed by 2 neuroradiologists and a radiology resident. Diagnostic performance of the SSS and individual spot characteristics were examined with multivariable regression, receiver operating characteristic analysis, and tests for trend.
  
  
  RESULTS
  SSS and spot number independently predicted significant, absolute, and relative hematoma expansion (P<0.05 each) and demonstrated near perfect interobserver agreement (κ=0.82 and κ=0.85, respectively). Incremental risk of hematoma expansion among spot-positive patients was not identified for SSS (P trend=0.720) but was demonstrated for spot number (P trend=0.050). Spot number and SSS demonstrated similar area under the curve (0.69 versus 0.68; P=0.306) for hematoma expansion.
  
  
  CONCLUSIONS
  Multicenter external validation of the SSS demonstrates that the spot number alone provides similar prediction but improved risk stratification of hematoma expansion compared with the SSS.
authors: Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors: Thien J
authors: TJ
authors: Huynh
authors: Andrew M
authors: AM
authors: Demchuk
authors: Dar
authors: D
authors: Dowlatshahi
authors: David J
authors: DJ
authors: Gladstone
authors: Ozlem
authors: O
authors: Krischek
authors: Alex
authors: A
authors: Kiss
authors: Michael D
authors: MD
authors: Hill
authors: Carlos A
authors: CA
authors: Molina
authors: David
authors: D
authors: Rodriguez-Luna
authors: Imanuel
authors: I
authors: Dzialowski
authors: Yolanda
authors: Y
authors: Silva
authors: Anna
authors: A
authors: Czlonkowska
authors: Cheemun
authors: C
authors: Lum
authors: Jean-Martin
authors: JM
authors: Boulanger
authors: Gord
authors: G
authors: Gubitz
authors: Rohit
authors: R
authors: Bhatia
authors: Vasantha
authors: V
authors: Padma
authors: Jayanta
authors: J
authors: Roy
authors: Carlos S
authors: CS
authors: Kase
authors: Richard I
authors: RI
authors: Aviv
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology; D019540:Area Under Curve; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000175:diagnosis*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants