title: The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The role of spot sign on computed tomography angiography (CTA) for predicting hematoma expansion (HE) after primary intracerebral hemorrhage (ICH) has been the focus of many studies. Our study sought to evaluate the predictive accuracy of spot signs for HE in a meta-analytic approach.
  
  
  METHODS
  The database of Pubmed, Embase, and the Cochrane Library were searched for eligible studies. Researches were included if they reported data on HE in primary ICH patients, assessed by spot sign on first-pass CTA. Studies with additional data of second-pass CTA, post-contrast CT (PCCT) and CT perfusion (CTP) were also included.
  
  
  RESULTS
  18 studies were pooled into the meta-analysis, including 14 studies of first-pass CTA, and 7 studies of combined CT modalities. In evaluating the accuracy of spot sign for predicting HE, studies of first-pass CTA showed that the sensitivity was 53% (95% CI, 49%-57%) with a specificity of 88% (95% CI, 86%-89%). The pooled positive likelihood ratio (PLR) was 4.70 (95% CI, 3.28-6.74) and the negative likelihood ratio (NLR) was 0.44 (95% CI, 0.34-0.58). For studies of combined CT modalities, the sensitivity was 73% (95% CI, 67%-79%) with a specificity of 88% (95% CI, 86%-90%). The aggregated PLR was 6.76 (95% CI, 3.70-12.34) and the overall NLR was 0.17 (95% CI 0.06-0.48).
  
  
  CONCLUSIONS
  Spot signs appeared to be a reliable imaging biomarker for HE. The additional detection of delayed spot sign was helpful in improving the predictive accuracy of early spot signs. Awareness of our results may impact the primary ICH care by providing supportive evidence for the use of combined CT modalities in detecting spot signs.
authors.affiliation: Department of Radiology, Chengdu Military General Hospital, Chengdu, China.
authors.forename: Fei-Zhou
authors.initials: FZ
authors.lastname: Du
authors.affiliation: Department of Radiology, Chengdu Military General Hospital, Chengdu, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Chengdu Military General Hospital, Chengdu, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Gu
authors.affiliation: Department of Radiology, Chengdu Military General Hospital, Chengdu, China.
authors.forename: Ci
authors.initials: C
authors.lastname: He
authors.affiliation: Department of Radiology, Chengdu Military General Hospital, Chengdu, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Guan
mesh_terms: D000792:Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000150:complications*; D018450:Disease Progression; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D012680:Sensitivity and Specificity