title: Showing no spot sign is a strong predictor of independent living after intracerebral haemorrhage.
abstract: BACKGROUND
  A spot sign on computed tomography angiography (CTA) is a potentially strong predictor of poor outcome on ultra-early radiological imaging. The aim of this study was to assess the spot sign as a predictor of functional outcome at 3 months as well as long-term mortality, with a focus on the ability to identify patients with a spontaneous, acceptable outcome.
  
  
  METHODS
  In a prospective, consecutive single-centre registry of acute stroke patients, we investigated patients with spontaneous intracerebral haemorrhage (ICH) admitted within 4.5 h after symptom onset from April 2009 to January 2013. The standard work-up in our centre included CTA for spot sign status, unless a contraindication was present. Modified Rankin Scale (mRS) scores were assessed at 3 months in the outpatient clinic or by telephone interviews. Long-term mortality was assessed by electronic chart follow-up for up to 1,500 days.
  
  
  RESULTS
  Of the 128 patients, 37 (28.9%) had a spot sign on admission CTA. The presence of a spot sign was associated with larger median admission haematoma volume [38.0 ml (IQR 18.0-78.0) vs. 12.0 ml (5.0-24.0); p<0.0001] and higher median National Institutes of Health Stroke Scale score [19 (IQR 12-23) vs. 12 (6-16); p<0.0001]. Three months after stroke, the median functional outcome was considerably better in patients without spot sign [mRS score 3 (IQR 2-4) vs. 6 (4-6); p<0.0001]. The absence of a spot sign showed a sensitivity and specificity for good outcome (mRS scores 0-2) of 0.91 and 0.36, respectively. The presence of a spot sign was, in multivariate models, an independent inverse predictor of good 3-month outcome (OR 0.17; 95% CI: 0.03-0.88) as well as a prominent independent predictor of poor 3-month outcome (mRS scores 5-6; OR 3.40; 95% CI: 1.10-10.5) and death during follow-up (HR 3.04; 95% CI: 1.45-6.34). Patients with a spot sign surviving the acute phase had long-term survival comparable to patients with no spot sign.
  
  
  CONCLUSIONS
  The absence or presence of a spot sign is a reliable ultra-early predictor of long-term mortality and functional outcome in patients with spontaneous ICH.
authors: Department of Radiology, Copenhagen University Hospital - Bispebjerg and Copenhagen Stroke Research Centre, Copenhagen, Denmark.
authors: Inger
authors: I
authors: Havsteen
authors: Christian
authors: C
authors: Ovesen
authors: Anders F
authors: AF
authors: Christensen
authors: Christine Krarup
authors: CK
authors: Hansen
authors: Jens Kellberg
authors: JK
authors: Nielsen
authors: Hanne
authors: H
authors: Christensen
mesh_terms: D000208:Acute Disease; D000368:Aged; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging / Q000209:etiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D057187:Independent Living; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol