title: The striate artery, hematoma, and spot sign on coronal images of computed tomography angiography in putaminal intracerebral hemorrhage.
abstract: OBJECTIVE
  A spot sign is a bright spot on computed tomography angiography source images, which is predictive of hematoma growth in spontaneous intracerebral hemorrhage, although the cause of the spot sign is unclear. Our aim was to investigate the spot sign seen on computed tomography angiography and a striate artery, which is a presumed site of intracerebral hemorrhage bleeding origin in the putamen.
  
  
  METHODS
  In consecutive cases of spontaneous intracerebral hemorrhage in the putamen, spot signs and striate arteries were evaluated. Coronal reformat images of computed tomography angiography were created to visualize the striate arteries. Acute deterioration, defined as hematoma enlargement, emergency hematoma removal, or death within the day of admission, was reviewed.
  
  
  RESULTS
  Of the 141 patients undergoing computed tomography angiography, 15 of the 30 patients (50%) who had spot signs showed an intrahematoma striate artery (termed spot and tail sign), which was a linear density extending from the middle cerebral artery toward the spot sign. Acute deterioration occurred more frequently in patients who had a spot and tail sign compared with patients who had spot signs without intrahematoma striate arteries (P<0.05). Multivariate analysis revealed that hematoma volume, spot signs, and intrahematoma striate arteries were independent predictors of acute deterioration (P<0.05).
  
  
  CONCLUSIONS
  The presence of a spot and tail sign, assumed to indicate active bleeding from the striate artery, could be a more sensitive predictor of acute deterioration than the presence of a simple spot sign.
authors.affiliation: Department of Neurosurgery, Tokai University, Kanagawa, Japan. sorimachi@tokai-u.jp
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Sorimachi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Osada
authors.forename: Tanefumi
authors.initials: T
authors.lastname: Baba
authors.forename: Go
authors.initials: G
authors.lastname: Inoue
authors.forename: Hideki
authors.initials: H
authors.lastname: Atsumi
authors.forename: Hideo
authors.initials: H
authors.lastname: Ishizaka
authors.forename: Kazuko
authors.initials: K
authors.lastname: Hotta
authors.forename: Naokazu
authors.initials: N
authors.lastname: Hayashi
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020146:Putaminal Hemorrhage / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: computed tomography angiography; intracerebral hemorrhage; perforator; predictors; spot sign