Venous phase of computed tomography angiography increases spot sign detection, but intracerebral hemorrhage expansion is greater in spot signs detected in arterial phase.
OBJECTIVE
Variability in computed tomography angiography (CTA) acquisitions may be one explanation for the modest accuracy of the spot sign for predicting intracerebral hemorrhage expansion detected in the multicenter Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study. This study aimed to determine the frequency of the spot sign in intracerebral hemorrhage and its relationship with hematoma expansion depending on the phase of image acquisition.


METHODS
PREDICT study was a prospective observational cohort study of patients with intracerebral hemorrhage presenting within 6 hours from onset. A post hoc analysis of the Hounsfield units of an artery and venous structure were measured on CTA source images of the entire PREDICT cohort in a core laboratory. Each CTA study was classified into arterial or venous phase and into 1 of 5 specific image acquisition phases. Significant hematoma expansion and total hematoma enlargement were recorded at 24 hours.


RESULTS
Overall (n=371), 77.9% of CTA were acquired in arterial phase. The spot sign, present in 29.9% of patients, was more frequently seen in venous phase as compared with arterial phase (39% versus 27.3%; P=0.041) and the later the phase of image acquisition (P=0.095). Significant hematoma expansion (P=0.253) and higher total hematoma enlargement (P=0.019) were observed more frequently among spot sign-positive patients with earlier phases of image acquisition.


CONCLUSIONS
Later image acquisition of CTA improves the frequency of spot sign detection. However, spot signs identified in earlier phases may be associated with greater absolute enlargement. A multiphase CTA including arterial and venous acquisitions could be optimal in patients with intracerebral hemorrhage.
From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (D.R.-L., T.S., M.D.H., A.M.D.); Departments of Medicine (Neurology) (D.D.) and Diagnostic Imaging, Neuroradiology Section (C.L.), The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (R.I.A., T.J.H.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona (IDIBGI) Foundation, Girona, Spain (Y.S.); Department of Neurology, University of Dresden, Dresden, Germany (I.D.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Quebec, Canada (J.-M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neuromedicine, AMRI Hospital Kolkata, Kolkata, India (J.R.).
David
D
Rodriguez-Luna
Dar
D
Dowlatshahi
Richard I
RI
Aviv
Carlos A
CA
Molina
Yolanda
Y
Silva
Imanuel
I
Dzialowski
Cheemun
C
Lum
Anna
A
Czlonkowska
Jean-Martin
JM
Boulanger
Carlos S
CS
Kase
Gord
G
Gubitz
Rohit
R
Bhatia
Vasantha
V
Padma
Jayanta
J
Roy
Teri
T
Stewart
Thien J
TJ
Huynh
Michael D
MD
Hill
Andrew M
AM
Demchuk
D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D015588:Observer Variation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
hematoma; intracerebral hemorrhage