title: Anatomic pattern of intracerebral hemorrhage expansion: relation to CT angiography spot sign and hematoma center.
abstract: OBJECTIVE
  We sought to identify baseline determinants of the anatomic pattern of hematoma expansion in patients with intracerebral hemorrhage and spot sign.
  
  
  METHODS
  We coregistered baseline and follow-up CT scans from 15 intracerebral hemorrhage patients and measured growth at each surface node from baseline to follow-up hematoma. We analyzed the effects of proximity to the spot sign or hematoma center on distance of expansion, controlling for covariates.
  
  
  RESULTS
  There was substantial node-to-node variation in the extent of expansion around each hematoma surface (mean coefficient of variation for expansion distance, 0.43; 95% confidence interval, 0.39-0.48), indicating nonuniform expansion. Closer proximity to the hematoma center was independently associated with increased expansion (0.185 mm greater expansion for each 1 mm closer to the center; P<0.0001). Closer proximity to the spot sign was not independently associated with increased expansion in models including both terms.
  
  
  CONCLUSIONS
  Hemorrhages expand nonuniformly around their surface with a tendency for greater expansion closer to their center. These findings provide a novel framework for analyzing mechanisms underlying hemorrhage growth and response to treatment.
authors.affiliation: From the Hemorrhagic Stroke Research Program, Department of Neurology (G.B., A.D., H.B.B., P.F., A. Vashkevich, A.A., K.S., A. Viswanathan, M.E.G., S.M.G.), Division of Neuroradiology, Department of Radiology (J.M.R.), Department of Emergency Medicine (J.N.G.), and Division of Neurocritical Care and Emergency Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Biostatistics, Harvard School of Public Health, Boston, MA (R.A.B.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.).
authors.forename: Grégoire
authors.initials: G
authors.lastname: Boulouis
authors.forename: Andrew
authors.initials: A
authors.lastname: Dumas
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Betensky
authors.forename: H Bart
authors.initials: HB
authors.lastname: Brouwers
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Fotiadis
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.forename: Alison
authors.initials: A
authors.lastname: Ayres
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: M Edip
authors.initials: ME
authors.lastname: Gurol
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: cerebral hemorrhage