title: Negative spot sign in primary intracerebral hemorrhage: potential impact in reducing imaging.
abstract: Intracerebral hemorrhage (ICH) is one of the most devastating and costly diagnoses in the USA. ICH is a common diagnosis, accounting for 10-15 % of all strokes and affecting 20 out of 100,000 people. The CT angiography (CTA) spot sign, or contrast extravasation into the hematoma, is a reliable predictor of hematoma expansion, clinical deterioration, and increased mortality. Multiple studies have demonstrated a high negative predictive value (NPV) for ICH expansion in patients without spot sign. Our aim is to determine the absolute NPV of the spot sign and clinical characteristics of patients who had ICH expansion despite the absence of a spot sign. This information may be helpful in the development of a cost effective imaging protocol of patients with ICH. During a 3-year period, 204 patients with a CTA with primary intracerebral hemorrhage were evaluated for subsequent hematoma expansion during their hospitalization. Patients with intraventricular hemorrhage were excluded. Clinical characteristics and antithrombotic treatment on admission were noted. The number of follow-up NCCT was recorded. Of the resulting 123 patients, 108 had a negative spot sign and 7 of those patients subsequently had significant hematoma expansion, 6 of which were on antithrombotic therapy. The NPV of the CTA spot sign was calculated at 0.93. In patients without antithrombotic therapy, the NPV was 0.98. In summary, the negative predictive value of the CTA spot sign for expansion of ICH, in the absence of antithrombotic therapy and intraventricular hemorrhage (IVH) on admission, is very high. These results have the potential to redirect follow-up imaging protocols and reduce cost.
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. jmromero@mgh.harvard.edu.
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Rania
authors.initials: R
authors.lastname: Hito
authors.affiliation: Division of Cardiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Dejam
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Laia Sero
authors.initials: LS
authors.lastname: Ballesteros
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Camilo Jaimes
authors.initials: CJ
authors.lastname: Cobos
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: J Ortiz
authors.initials: JO
authors.lastname: Liévano
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Viesha A
authors.initials: VA
authors.lastname: Ciura
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.|Service de Neuroradiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Barnaure
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Haus Ost 22 Martinistr 52, 20246, Hamburg, Germany.
authors.forename: Marielle
authors.initials: M
authors.lastname: Ernst
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Afonso P
authors.initials: AP
authors.lastname: Liberato
authors.affiliation: Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Gilberto R
authors.initials: GR
authors.lastname: Gonzalez
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: CT; Intracerebral hemorrhage; Spot sign; Stroke