title: Predicting Intracerebral Hemorrhage Growth With the Spot Sign: The Effect of Onset-to-Scan Time.
abstract: OBJECTIVE
  Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign.
  
  
  METHODS
  We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates.
  
  
  RESULTS
  Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours (P<0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased (P=0.004), with positive predictive values decreasing from 53% to 33%.
  
  
  CONCLUSIONS
  The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.). ddowlat@toh.on.ca.
authors: Dar
authors: D
authors: Dowlatshahi
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: H Bart
authors: HB
authors: Brouwers
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Andrew M
authors: AM
authors: Demchuk
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Michael D
authors: MD
authors: Hill
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Richard I
authors: RI
authors: Aviv
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Lee-Anne
authors: LA
authors: Ufholz
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Michael
authors: M
authors: Reaume
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Max
authors: M
authors: Wintermark
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: J Claude
authors: JC
authors: Hemphill
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Yasuo
authors: Y
authors: Murai
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Yongjun
authors: Y
authors: Wang
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Xingquan
authors: X
authors: Zhao
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Yilong
authors: Y
authors: Wang
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Na
authors: N
authors: Li
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Takatoshi
authors: T
authors: Sorimachi
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Mitsunori
authors: M
authors: Matsumae
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Thorsten
authors: T
authors: Steiner
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Timolaos
authors: T
authors: Rizos
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Steven M
authors: SM
authors: Greenberg
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Javier M
authors: JM
authors: Romero
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Jonathan
authors: J
authors: Rosand
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Joshua N
authors: JN
authors: Goldstein
authors: From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
authors: Mukul
authors: M
authors: Sharma
mesh_terms: D002533:Cerebral Angiography / Q000379:methods / Q000639:trends*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018450:Disease Progression; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D011237:Predictive Value of Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000639:trends*
keywords: CT angiography; cerebral hemorrhage; hematoma expansion; intracerebral hemorrhage; spot sign