title: Leakage Sign for Primary Intracerebral Hemorrhage: A Novel Predictor of Hematoma Growth.
abstract: OBJECTIVE
  Recent studies of intracerebral hemorrhage treatments have highlighted the need to identify reliable predictors of hematoma expansion. Several studies have suggested that the spot sign on computed tomographic angiography (CTA) is a sensitive radiological predictor of hematoma expansion in the acute phase. However, the spot sign has low sensitivity for hematoma expansion. In this study, we evaluated the usefulness of a novel predictive method, called the leakage sign.
  
  
  METHODS
  We performed CTA for 80 consecutive patients presenting with spontaneous intracerebral hemorrhage. Two scans were completed: CTA phase and delayed phase (5 minutes after the CTA phase). By comparing the CTA phase images, we set a region of interest with a 10-mm diameter and calculated the Hounsfield units. We defined a positive leakage sign as a >10% increase in Hounsfield units in the region of interest. Additionally, hematoma expansion was determined on plain computed tomography at 24 hours in patients who did not undergo emergent surgery.
  
  
  RESULTS
  Positive spot signs and leakage signs were present in 18 (22%) patients and 35 (43%) patients, respectively. The leakage sign had higher sensitivity (93.3%) and specificity (88.9%) for hematoma expansion than the spot sign. The leakage sign, but not the spot sign, was significantly related with poor outcomes (severely disabled, vegetative state, and death) in all of the patients (P=0.03) and in patients with a hemorrhage in the putamen (P=0.0016).
  
  
  CONCLUSIONS
  The results indicate that the leakage sign is a useful and sensitive method to predict hematoma expansion.
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan. orito_kimihiko@kurume-u.ac.jp.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Orito
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Hirohata
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takeshige
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Takachika
authors.initials: T
authors.lastname: Aoki
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Gousuke
authors.initials: G
authors.lastname: Hattori
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Sakata
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Toshi
authors.initials: T
authors.lastname: Abe
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Yuusuke
authors.initials: Y
authors.lastname: Uchiyama
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: From the Departments of Neurosurgery (K.O., M.H., Y.N., N.T., T. Aoki, G.H., K.S., M.M.) and Radiology (T. Abe, Y.U.) and Departments of Emergency and Acute Intensive Care Medicine (T.S.), Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: hematoma; hematoma expansion; intracerebral hemorrhage; leakage sign; spot sign