title: Occurrence of spot signs from hypodensity areas on precontrast CT in intracerebral hemorrhage.
abstract: OBJECTIVE
  Both the spot signs, which is a bright spot on computed tomography angiography (CTA) source images, and hypodensity areas within a hematoma on precontrast CT scans, which presumably represent uncoagulated blood, have been reported to be predictive of hematoma enlargement in acute spontaneous intracerebral hematoma (ICH). The aim was to investigate densities on precontrast CT scans in an area within a hematoma that matched the locations of spot signs on CTA source images.
  
  
  METHODS
  In consecutive cases of spontaneous ICH admitted within 6 h after onset, early spot signs on CTA source images and delayed spot signs on delayed-phase CT scans 90 s after CTA were evaluated.
  
  
  RESULTS
  Of 177 patients undergoing CTA, 41 (23.2%) showed early spot signs. Among 146 patients who underwent delayed-phase CT scans, 23 (15.8%) demonstrated delayed spot signs but not early spot signs. Spot signs originated from hypodensity areas, including densities <50 HU, in 30 of 35 patients (85.7%) with early spot signs and in 8 of 23 (34.8%) with delayed spot signs. Early spot signs arose from hypodensity areas more frequently than delayed spot signs (p < 0.05). Hematoma enlargement was observed in 10 of 24 patients (41.7%) with early spot signs, but in none with delayed spot signs.
  
  
  CONCLUSIONS
  Some hypodensity areas within ICHs may indicate uncoagulated blood related to ongoing leakage, which are seen as spot signs. Minimum densities in hypodensity areas might correlate with the speed and volume of bleeding.
authors.affiliation: a Department of Neurosurgery , Tokai University , Kanagawa , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nishiyama
authors.affiliation: a Department of Neurosurgery , Tokai University , Kanagawa , Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Sorimachi
authors.affiliation: a Department of Neurosurgery , Tokai University , Kanagawa , Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Aoki
authors.affiliation: a Department of Neurosurgery , Tokai University , Kanagawa , Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Inoue
authors.affiliation: a Department of Neurosurgery , Tokai University , Kanagawa , Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
keywords: Computed tomography; computed tomography angiography; hematoma enlargement; intracerebral hemorrhage