title: "Dynamic spot sign" on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage.
abstract: OBJECTIVE
  To evaluate the association between dynamic progressive enhancing foci ("dynamic spot sign") in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion.
  
  
  METHODS
  One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed.
  
  
  RESULTS
  Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386-590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123-1295.488), P < 0.0001.
  
  
  CONCLUSIONS
  The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign.
  
  
  CONCLUSIONS
  • It is important to identify potential progression of spontaneous intracerebral haemorrhage. • Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion. • The CTP dynamic spot sign may be present throughout arterial to venous phase imaging. • The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.
authors.affiliation: Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors.forename: Sheng-Jun
authors.initials: SJ
authors.lastname: Sun
authors.forename: Pei-Yi
authors.initials: PY
authors.lastname: Gao
authors.forename: Bin-Bin
authors.initials: BB
authors.lastname: Sui
authors.forename: Xin-Yi
authors.initials: XY
authors.lastname: Hou
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Jing
authors.initials: J
authors.lastname: Xue
authors.forename: Ren-You
authors.initials: RY
authors.lastname: Zhai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000000981:diagnostic imaging; D006470:Hemorrhage; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010477:Perfusion; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*