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Horn M, Teleg E, Tanaka K, Al Sultan A, Kasickova L, Ohara T, Ojha P, Wasyliw S, Marzoughi S, Banerjee A, Kulkarni G, Horn K, Bobyn A, Neweduk A, Singh N, Qiu W, Rodriguez-Luna D, Dowlatshahi D, Goyal M, Menon BK, Demchuk AM. Timing of Spot Sign Appearance, Spot Sign Volume, and Leakage Rate among Phases of Multiphase CTA Predict Intracerebral Hemorrhage Growth. AJNR Am J Neuroradiol 2024; 45:693-700. [PMID: 38782592 DOI: 10.3174/ajnr.a8254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND AND PURPOSE The presence of spot sign is associated with a high risk of hematoma growth. Our aim was to investigate the timing of the appearance, volume, and leakage rate of the spot sign for predicting hematoma growth in acute intracerebral hemorrhage using multiphase CTA. MATERIALS AND METHODS In this single-center retrospective study, multiphase CTA in 3 phases was performed in acute intracerebral hemorrhage (defined as intraparenchymal ± intraventricular hemorrhages). Phases of the spot sign first appearance, spot sign volumes (microliter), and leakage rates among phases (microliter/second) were measured. Associations between baseline clinical and imaging variables including spot sign volume parameters (volume and leakage rate divided by median) and hematoma growth (>6 mL) were investigated using regression models. Receiver operating characteristic analysis was used as appropriate. RESULTS Two hundred seventeen patients (131 men; median age, 70 years) were included. The spot sign was detected in 21.7%, 30.0%, and 29.0% in the first, second, and third phases, respectively, with median volumes of 19.7, 31.4, and 34.8 μl in these phases. Hematoma growth was seen in 44 patients (20.3%). By means of modeling, the following variables, namely the spot sign appearing in the first phase, first phase spot sign volume, spot sign appearing in the second or third phase, and spot sign positive and negative leakage rates, were associated with hematoma growth. Among patients with a spot sign, the absolute leakage rate accounting for both positive and negative leakage rates was also associated with hematoma growth (per 1-μl/s increase; OR, 1.26; 95% CI, 1.04-1.52). Other hematoma growth predictors were stroke history, baseline NIHSS score, onset-to-imaging time, and baseline hematoma volume (all P values < .05). CONCLUSIONS The timing of the appearance of the spot sign, volume, and leakage rate were all associated with hematoma growth. Development of automated software to generate these spot sign volumetric parameters would be an important next step to maximize the potential of temporal intracerebral hemorrhage imaging such as multiphase CTA for identifying those most at risk of hematoma growth.
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Affiliation(s)
- MacKenzie Horn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Ericka Teleg
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Koji Tanaka
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Abdulaziz Al Sultan
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Linda Kasickova
- Department of Neurology (L.K.), University Ostrava, Ostrava, Czech Republic
| | - Tomoyuki Ohara
- Department of Neurology (T.O.), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Piyush Ojha
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Sanchea Wasyliw
- Department of Medicine (S.W.), Division of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - Sina Marzoughi
- Department of Medicine (S.M.), Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ankur Banerjee
- Department of Medicine (A. Banerjee), Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Girish Kulkarni
- Department of Neurology (G.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kennedy Horn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Amy Bobyn
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Anneliese Neweduk
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Nishita Singh
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
| | - Wu Qiu
- Department of Biomedical Engineering (W.Q.), Huazhong University of Science and Technology, Wuhan, China
| | - David Rodriguez-Luna
- Department of Neurology (D.R.-L.), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dar Dowlatshahi
- Department of Medicine (D.D.), Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mayank Goyal
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences (B.K.M.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrew M Demchuk
- From the Foothills Medical Centre, Department of Clinical Neurosciences (M.H., E.T., K.T., A.A.S., P.O., K.H., A. Bobyn, A.N., N.S., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Department of Radiology (M.G., B.K.M., A.M.D.), University of Calgary, Calgary, Alberta, Canada
- Hotchikiss Brain Institute (M.G., B.K.M., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada
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Truong MQ, Metcalfe AV, Ovenden CD, Kleinig TJ, Barras CD. Intracerebral hemorrhage markers on non-contrast computed tomography as predictors of the dynamic spot sign on CT perfusion and associations with hematoma expansion and outcome. Neuroradiology 2022; 64:2135-2144. [PMID: 36076088 DOI: 10.1007/s00234-022-03032-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess the association between non-contrast computed tomography (NCCT) hematoma markers and the dynamic spot sign on computed tomography perfusion (CTP), and their associations with hematoma expansion, clinical outcome, and in-hospital mortality. METHODS Patients who presented with intracerebral hemorrhage (ICH) to a stroke center over an 18-month period and underwent baseline NCCT and CTP, and a follow-up NCCT within 24 h after the baseline scan were included. The initial and follow-up hematoma volumes were calculated. Two raters independently assessed the baseline NCCT for hematoma markers and concurrently assessed the CTP for the dynamic spot sign. Univariate and multivariate logistic regression analyses were performed to assess the association between the hematoma markers and the dynamic spot sign, adjusting for known ICH expansion predictors. RESULTS Eighty-five patients were included in our study and 55 patients were suitable for expansion analysis. Heterogeneous density was the only NCCT hematoma marker to be associated with the dynamic spot sign after multivariate analysis (odds ratio, 58.61; 95% confidence interval, 9.13-376.05; P < 0.001). The dynamic spot sign was present in 22 patients (26%) and significantly predicted hematoma expansion (odds ratio, 36.6; 95% confidence interval, 2.51-534.2; P = 0.008). All patients with a spot sign had a swirl sign. A co-located hypodensity and spot sign was significantly associated with in-hospital mortality (odds ratio, 6.17; 95% confidence interval, 1.09-34.78; P = 0.039). CONCLUSION Heterogeneous density and swirl sign are associated with the dynamic spot sign. The dynamic spot sign is a stronger predictor than NCCT hematoma markers of significant hematoma expansion. A co-located spot sign and hypodensity predicts in-hospital mortality.
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Affiliation(s)
| | - Andrew Viggo Metcalfe
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher Dillon Ovenden
- Faculty of Health and Medical Sciences, Surgical Specialties, The University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy John Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Christen David Barras
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
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Schlunk F, Kuthe J, Harmel P, Audebert H, Hanning U, Bohner G, Scheel M, Kleine J, Nawabi J. Volumetric accuracy of different imaging modalities in acute intracerebral hemorrhage. BMC Med Imaging 2022; 22:9. [PMID: 35033012 PMCID: PMC8760700 DOI: 10.1186/s12880-022-00735-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Follow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth. This study assesses the volumetric accuracy of different imaging modalities (MRI, CT angiography, postcontrast CT) to measure hematoma size. Methods 28 patients with acute spontaneous intracerebral hemorrhage referred to a tertiary stroke center were retrospectively included between 2018 and 2019. Inclusion criteria were (1) spontaneous intracerebral hemorrhage (supra- or infratentorial), (2) noncontrast CT imaging performed on admission, (3) follow-up imaging (CT angiography, postcontrast CT, MRI), and (4) absence of hematoma expansion confirmed by a third cranial image within 6 days. Two independent raters manually measured hematoma volume by drawing a region of interest on axial slices of admission noncontrast CT scans as well as on follow-up imaging (CT angiography, postcontrast CT, MRI) using a semi-automated segmentation tool (Visage image viewer; version 7.1.10). Results were compared using Bland–Altman plots. Results Mean admission hematoma volume was 18.79 ± 19.86 cc. All interrater and intrarater intraclass correlation coefficients were excellent (1; IQR 0.98–1.00). In comparison to hematoma volume on admission noncontrast CT volumetric measurements were most accurate in patients who received postcontrast CT (bias of − 2.47%, SD 4.67: n = 10), while CT angiography often underestimated hemorrhage volumes (bias of 31.91%, SD 45.54; n = 20). In MRI sequences intracerebral hemorrhage volumes were overestimated in T2* (bias of − 64.37%, SD 21.65; n = 10). FLAIR (bias of 6.05%, SD 35.45; n = 13) and DWI (bias of-14.6%, SD 31.93; n = 12) over- and underestimated hemorrhagic volumes. Conclusions Volumetric measurements were most accurate in postcontrast CT while CT angiography and MRI sequences often substantially over- or underestimated hemorrhage volumes. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00735-3.
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Affiliation(s)
- Frieder Schlunk
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.
| | - Johannes Kuthe
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter Harmel
- Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Heinrich Audebert
- Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Justus Kleine
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jawed Nawabi
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany.,Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Mathews DJ, Ram SA, Maramattom BV. CT "Spot" and "Leakage" Signs Predicting Intracerebral Hematoma Expansion. Neurol India 2021; 69:1119-1120. [PMID: 34507477 DOI: 10.4103/0028-3886.325367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Dhinu J Mathews
- Department of Neurology, Aster Medcity, Kochi, Kerala, India
| | - S Ananth Ram
- Department of Neurology, Aster Medcity, Kochi, Kerala, India
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Abstract
PURPOSE OF REVIEW This article describes how imaging can be used by physicians in diagnosing, determining prognosis, and making appropriate treatment decisions in a timely manner in patients with acute stroke. RECENT FINDINGS Advances in acute stroke treatment, including the use of endovascular thrombectomy in patients with large vessel occlusion and, more recently, of IV thrombolysis in an extended time window, have resulted in a paradigm shift in how imaging is used in patients with acute stroke. This paradigm shift, combined with the understanding that "time is brain," means that imaging must be fast, reliable, and available around the clock for physicians to make appropriate clinical decisions. CT has therefore become the primary imaging modality of choice. Recognition of a large vessel occlusion using CT angiography has become essential in identifying patients for endovascular thrombectomy, and techniques such as imaging collaterals on CT angiography or measuring blood flow to predict tissue fate using CT perfusion have become useful tools in selecting patients for acute stroke therapy. Understanding the use of these imaging modalities and techniques in dealing with an emergency such as acute stroke has therefore become more important than ever for physicians treating patients with acute stroke. SUMMARY Imaging the brain and the blood vessels supplying it using modern tools and techniques is a key step in understanding the pathophysiology of acute stroke and making appropriate and timely clinical decisions.
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Dowlatshahi D, Chung HS, Reaume M, Hogan MJ, Blacquiere D, Stotts G, Shamy M, Momoli F, Aviv R, Demchuk AM, Chakraborty S. Prevalence and the predictive performance of the dynamic CT-angiography spot sign in an observational cohort with intracerebral hemorrhage. Medicine (Baltimore) 2020; 99:e23278. [PMID: 33217856 PMCID: PMC7676581 DOI: 10.1097/md.0000000000023278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The CT-angiography (CTA) spot sign is a predictor of hematoma expansion (HE). We have previously reported on the use of dynamic CTA (dCTA) to detect spot sign, and to study its formation over the acquisition period. In this study, we report the frequency of dCTA spot sign in acute intracerebral hemorrhage, its sensitivity and specificity to predict HE, and explore the rate of contrast extravasation in relation to hematoma growth.We enrolled consecutive patients presenting with primary intracerebral hemorrhage within 4.5 hours. All patients underwent a dCTA protocol acquired over 60 seconds following contrast injection. We calculated frequency of the dCTA spot sign, predictive performance, and rate of contrast extravasation. We compared extravasation rates to the dichotomous definition of significant HE (defined as 6 mL or 33% growth).In 78 eligible patients, dCTA spot sign frequency was 44.9%. In 61 patients available for expansion analysis, sensitivity and specificity of dCTA spot sign was 65.4% and 62.9%, respectively. Contrast extravasation rate did not significantly predict HE (Odds Ratio 15.6 for each mL/min [95% confidence interval 0.30-820.25], P = .17). Correlation between extravasation rate and HE was low (r = 0.297, P= .11). Patients with significant HE had a higher rate of extravasation as compared to those without (0.12 mL/min vs 0.04 mL/min, P = .03).Dynamic CTA results in a higher frequency of spot sign positivity, but with modest sensitivity and specificity to predict expansion. Extravasation rate is likely related to HE, but a single measurement may be insufficient to predict the magnitude of expansion.
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Affiliation(s)
- Dar Dowlatshahi
- Department of Medicine
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute, Ottawa
| | | | | | | | | | | | | | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa and Ottawa Hospital Research Institute, Ottawa
| | - Richard Aviv
- Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Andrew M. Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB
| | - Santanu Chakraborty
- Department of Medical Imaging, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
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Chung HS, Chakraborty S, Reaume M, Yogendrakumar V, Hogan MJ, Blacquiere D, Stotts G, Shamy M, Aviv RI, Dowlatshahi D. Distribution and predictive performance of the temporal phase of dynamic spot sign appearance in acute intracerebral hemorrhage. PLoS One 2020; 15:e0236196. [PMID: 32760077 PMCID: PMC7410294 DOI: 10.1371/journal.pone.0236196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/30/2020] [Indexed: 12/03/2022] Open
Abstract
Background Dynamic CT angiography (dCTA) contrast extravasation, known as the “dynamic spot sign”, can predict hematoma expansion (HE) in intracerebral hemorrhage (ICH). Recent reports suggest the phase of spot sign appearance is related to the magnitude of HE. We used dCTA to explore the association between the phase of spot sign appearance and HE, clinical outcome, and contrast extravasation rates. Methods We assessed consecutive patients who presented with primary ICH within 4.5 hours from symptom onset who underwent a standardized dCTA protocol and were spot sign positive. The independent variable was the phase of spot sign appearance. The primary outcome was significant HE (either 6 mL or 33% growth). Secondary outcomes included total absolute HE, mortality, and discharge mRS. Mann-Whitney U, Fisher’s exact test, and logistic regression were used, as appropriate. Results Of the 35 patients with spot signs, 27/35 (77%) appeared in the arterial phase and 8/35 (23%) appeared in the venous phase. Thirty patients had follow-up CT scans. Significant HE was seen in 14/23 (60.87%) and 3/7 (42.86%) of arterial and venous cohorts, respectively (p = 0.67). The sensitivity and specificity in predicting significant HE were 82% and 31% for the arterial phase and 18% and 69% for the venous phase, respectively. There was a non-significant trend towards greater total HE, in-hospital mortality, and discharge mRS of 4–6 in the arterial spot sign cohort. Arterial spot signs demonstrated a higher median contrast extravasation rate (0.137 mL/min) compared to venous spot signs (0.109 mL/min). Conclusion Our exploratory analyses suggest that spot sign appearance in the arterial phase may be more likely associated with HE and poorer prognosis in ICH. This may be related to higher extravasation rates of arterial phase spot signs. However, further studies with larger sample sizes are warranted to confirm the findings.
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Affiliation(s)
- Hee Sahng Chung
- Department of Medicine, University of Ottawa, Ottawa, Canada
- * E-mail:
| | | | - Michael Reaume
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Grant Stotts
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Richard I. Aviv
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, Canada
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Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review. Neuroradiology 2020; 62:273-281. [PMID: 31901972 PMCID: PMC7044254 DOI: 10.1007/s00234-019-02349-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/15/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH). METHODS A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019. RESULTS We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis. CONCLUSION The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base.
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Hussein O, Sawalha K, Fritz J, Abd Elazim A, Hamed M, Wei L, Mainali S. The Significance of Contrast Density of the Computed Tomography-Angiographic Spot Sign and its Correlation with Hematoma Expansion. J Stroke Cerebrovasc Dis 2019; 28:1474-1482. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/24/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022] Open
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Computed Tomography Angiography Spot Sign as an Indicator for Ultra-Early Stereotactic Aspiration of Intracerebral Hemorrhage. World Neurosurg 2018; 109:e136-e143. [DOI: 10.1016/j.wneu.2017.09.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
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Rodriguez-Luna D, Coscojuela P, Rodriguez-Villatoro N, Juega JM, Boned S, Muchada M, Pagola J, Rubiera M, Ribo M, Tomasello A, Demchuk AM, Goyal M, Molina CA. Multiphase CT Angiography Improves Prediction of Intracerebral Hemorrhage Expansion. Radiology 2017; 285:932-940. [DOI: 10.1148/radiol.2017162839] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David Rodriguez-Luna
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Pilar Coscojuela
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jesús M. Juega
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Sandra Boned
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marián Muchada
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Jorge Pagola
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marta Rubiera
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Marc Ribo
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Alejandro Tomasello
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Andrew M. Demchuk
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Mayank Goyal
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
| | - Carlos A. Molina
- From the Stroke Unit, Departments of Neurology (D.R.L., N.R.V., J.M.J., S.B., M.M, J.P., M. Rubiera, M. Ribo, C.A.M.) and Neuroradiology (P.C., A.T.), Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Ps Vall d’Hebron 119, 08035 Barcelona, Spain; and Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (A.M.D., M.G.)
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12
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Morotti A, Brouwers HB, Romero JM, Jessel MJ, Vashkevich A, Schwab K, Afzal MR, Cassarly C, Greenberg SM, Martin RH, Qureshi AI, Rosand J, Goldstein JN. Intensive Blood Pressure Reduction and Spot Sign in Intracerebral Hemorrhage: A Secondary Analysis of a Randomized Clinical Trial. JAMA Neurol 2017. [PMID: 28628707 DOI: 10.1001/jamaneurol.2017.1014] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The computed tomographic angiography (CTA) spot sign is associated with intracerebral hemorrhage (ICH) expansion and may mark those patients most likely to benefit from intensive blood pressure (BP) reduction. Objective To investigate whether the spot sign is associated with ICH expansion across a wide range of centers and whether intensive BP reduction decreases hematoma expansion and improves outcome in patients with ICH and a spot sign. Design, Setting, and Participants SCORE-IT (Spot Sign Score in Restricting ICH Growth) is a preplanned prospective observational study nested in the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) randomized clinical trial. Participants included consecutive patients with primary ICH who underwent a CTA within 8 hours from onset at 59 sites from May 15, 2011, through December 19, 2015. Data were analyzed for the present study from July 1 to August 31, 2016. Main Outcomes and Measures Patients in ATACH-II were randomized to intensive (systolic BP target, <140 mm Hg) vs standard (systolic BP target, <180 mm Hg) BP reduction within 4.5 hours from onset. Expansion of ICH was defined as hematoma growth of greater than 33%, and an unfavorable outcome was defined as a 90-day modified Rankin Scale score of 4 or greater (range, 0-6). The association among BP reduction, ICH expansion, and outcome was investigated with multivariable logistic regression. Results A total of 133 patients (83 men [62.4%] and 50 women [37.6%]; mean [SD] age, 61.9 [13.1] years) were included. Of these, 53 (39.8%) had a spot sign, and 24 of 123 without missing data (19.5%) experienced ICH expansion. The spot sign was associated with expansion with sensitivity of 0.54 (95% CI, 0.34-0.74) and specificity of 0.63 (95% CI, 0.53-0.72). After adjustment for potential confounders, intensive BP treatment was not associated with a significant reduction of ICH expansion (relative risk, 0.83; 95% CI, 0.27-2.51; P = .74) or improved outcome (relative risk of 90-day modified Rankin Scale score ≥4, 1.24; 95% CI, 0.53-2.91; P = .62) in spot sign-positive patients. Conclusions and Relevance The predictive performance of the spot sign for ICH expansion was lower than in prior reports from single-center studies. No evidence suggested that patients with ICH and a spot sign specifically benefit from intensive BP reduction. Trial Registration clinicaltrials.gov Identifier: NCT01176565.
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Affiliation(s)
- Andrea Morotti
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - H Bart Brouwers
- Department of Neurosurgery, Brain Center Rudolf Magnus University Medical Center, Utrecht, the Netherlands
| | - Javier M Romero
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael J Jessel
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anastasia Vashkevich
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin Schwab
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Steven M Greenberg
- J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Renee Hebert Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua N Goldstein
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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13
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Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4137210. [PMID: 28852647 PMCID: PMC5567448 DOI: 10.1155/2017/4137210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/21/2017] [Accepted: 07/12/2017] [Indexed: 01/03/2023]
Abstract
Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage and leads to high rates of mortality and morbidity. Currently, contrast extravasation within hematoma, termed the spot sign on computed tomography angiography (CTA), has been identified as a strong independent predictor of early hematoma expansion. Past studies indicate that the spot sign is a dynamic entity and is indicative of active hemorrhage. Furthermore, to enhance the spot sign's accuracy of predicting HE, spot parameters observed on CTA or dynamic CTA were used for its quantification. In addition, spot signs detected on multiphase CTA and dynamic CTA are shown to have higher sensitivity and specificity when compared with simple standardized spot sign detection in recent studies. Based on the spot sign, novel methods such as leakage sign and rate of contrast extravasation were explored to redefine HE prediction in combination with clinical characteristics and spot sign on CTA to assist clinical judgment. The spot sign is an accepted independent predictor of active hemorrhage and is used in both secondary intracerebral hemorrhage and the process of surgical assessment for hemorrhagic risk in patients with ischemic stroke. Spot sign predicts patients at high risk for hematoma expansion.
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14
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Phantom-based standardization of CT angiography images for spot sign detection. Neuroradiology 2017; 59:839-844. [PMID: 28730267 DOI: 10.1007/s00234-017-1857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance. METHODS A custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%. RESULTS A total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8 vs 38.9% p < 0.001). All spot signs identified in the non-calibrated analysis remained positive after calibration. Calibrated CTA images had higher sensitivity for ICH expansion (76 vs 52%) but inferior specificity (35 vs 63%) compared with uncalibrated images. CONCLUSION Normalization of CTA images using phantom data is a feasible strategy to obtain consistent image quantification for spot sign analysis across different sites and may improve sensitivity for identification of ICH expansion.
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15
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Nishiyama J, Sorimachi T, Aoki R, Inoue G, Matsumae M. Occurrence of spot signs from hypodensity areas on precontrast CT in intracerebral hemorrhage. Neurol Res 2017; 39:419-425. [DOI: 10.1080/01616412.2017.1297341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jun Nishiyama
- Department of Neurosurgery, Tokai University, Kanagawa, Japan
| | | | - Rie Aoki
- Department of Neurosurgery, Tokai University, Kanagawa, Japan
| | - Go Inoue
- Department of Neurosurgery, Tokai University, Kanagawa, Japan
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16
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Wang B, Yan S, Xu M, Zhang S, Liu K, Hu H, Selim M, Lou M. Timing of Occurrence Is the Most Important Characteristic of Spot Sign. Stroke 2016; 47:1233-1238. [PMID: 27026627 DOI: 10.1161/strokeaha.116.012697] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Most previous studies have used single-phase computed tomographic angiography to detect the spot sign, a marker for hematoma expansion (HE) in spontaneous intracerebral hemorrhage. We investigated whether defining the spot sign based on timing on perfusion computed tomography (CTP) would improve its specificity for predicting HE. METHODS We prospectively enrolled supratentorial spontaneous intracerebral hemorrhage patients who underwent CTP within 6 hours of onset. Logistic regression was performed to assess the risk factors for HE and poor outcome. Predictive performance of individual CTP spot sign characteristics were examined with receiver operating characteristic analysis. RESULTS Sixty-two men and 21 women with spontaneous intracerebral hemorrhage were included in this analysis. Spot sign was detected in 46% (38/83) of patients. Receiver operating characteristic analysis indicated that the timing of spot sign occurrence on CTP had the greatest area under receiver operating characteristic curve for HE (0.794; 95% confidence interval, 0.630-0.958; P=0.007); the cutoff time was 23.13 seconds. On multivariable analysis, the presence of early-occurring spot sign (ie, spot sign before 23.13 seconds) was an independent predictor not only of HE (odds ratio=28.835; 95% confidence interval, 6.960-119.458; P<0.001), but also of mortality at 3 months (odds ratio =22.377; 95% confidence interval, 1.773-282.334; P=0.016). Moreover, the predictive performance showed that the redefined early-occurring spot sign maintained a higher specificity for HE compared with spot sign (91% versus 74%). CONCLUSIONS Redefining the spot sign based on timing of contrast leakage on CTP to determine early-occurring spot sign improves the specificity for predicting HE and 3-month mortality. The use of early-occurring spot sign could improve the selection of ICH patients for potential hemostatic therapy.
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Affiliation(s)
- Binli Wang
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Mengjun Xu
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Sheng Zhang
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Keqin Liu
- Department of Neurology, Hangzhou First People's Hospital, Hangzhou, China
| | - Haitao Hu
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Min Lou
- Department of Neurology, the 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Demchuk AM, Menon BK, Goyal M. Comparing Vessel Imaging: Noncontrast Computed Tomography/Computed Tomographic Angiography Should Be the New Minimum Standard in Acute Disabling Stroke. Stroke 2015; 47:273-81. [PMID: 26645255 DOI: 10.1161/strokeaha.115.009171] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew M Demchuk
- From the Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Bijoy K Menon
- From the Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- From the Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Liebeskind DS, Feldmann E. Imaging of cerebrovascular disorders: precision medicine and the collaterome. Ann N Y Acad Sci 2015; 1366:40-8. [PMID: 25922154 DOI: 10.1111/nyas.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 12/29/2022]
Abstract
Imaging of stroke and neurovascular disorders has profoundly enhanced clinical practice and related research during the last 40 years since the introduction of computed tomography (CT) and magnetic resonance imaging (MRI) enabled mapping of the brain. We highlight recent advances in neurovascular imaging. We describe how the convergence of readily available data and new clinical trial paradigms will recast our methods for studying the neurovascular patient. The application of a precision medicine approach to the collaterome, a comprehensive synthesis of neurovascular pathophysiology, will entail novel methods for clinical trial randomization, collection of routine and clinical trial imaging results, data archiving, and analysis.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core and the University of California, Los Angeles Stroke Center, Los Angeles, California
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19
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Abstract
Because of the different attenuations of tissues at different energy levels, dual-energy CT offers tissue differentiation and characterization, reduction of artifacts, and remodeling of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), hereby creating new opportunities and insights in CT imaging. The applications for dual-energy imaging in neuroradiology are various and still expanding. Automated bone removal is used in CT angiography and CT venography of the intracranial vessels. Monoenergetic reconstructions can be used in patients with or without metal implants in the brain and spine to reduce artifacts, improve CNR and SNR, or to improve iodine conspicuity. Differentiation of iodine and hemorrhage is used in high-density lesions, after intra-arterial recanalization in stroke patients or after administration of contrast media. Detection of underlying (vascular and non-vascular) pathology and spot sign can be used in patients presenting with (acute) intracranial hemorrhage.
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Affiliation(s)
- Alida A. Postma
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annika A. R. Stadler
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage: a systematic review and meta-analysis. PLoS One 2014; 9:e115777. [PMID: 25541717 PMCID: PMC4277365 DOI: 10.1371/journal.pone.0115777] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/26/2014] [Indexed: 12/02/2022] Open
Abstract
Purpose 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. Materials and 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.
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Tsukabe A, Watanabe Y, Tanaka H, Kunitomi Y, Nishizawa M, Arisawa A, Yoshiya K, Shimazu T, Tomiyama N. Prevalence and diagnostic performance of computed tomography angiography spot sign for intracerebral hematoma expansion depend on scan timing. Neuroradiology 2014; 56:1039-45. [PMID: 25228452 DOI: 10.1007/s00234-014-1430-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The computed tomography angiography (CTA) spot sign correlates with intracerebral hemorrhage (ICH) expansion; however, various diagnostic performances for hematoma expansion, especially in sensitivity, have been reported. We aimed to assess the impact of scan timing of CTA on the diagnostic performance of the CTA spot sign for ICH expansion in two different arterial phases within patients. METHODS Eighty-three consecutive patients with primary ICH who received two sequential CTAs were recruited. Two neuroradiologists reviewed CTAs for CTA spot signs, while one reviewed initial and follow-up non-contrast CT for measuring ICH volume. The time interval between two phases was then calculated, and the diagnostic performance of CTA spot sign in each phase was evaluated. RESULTS CTA spot signs were observed in 20/83 (24.1 %) patients in the early phase and 44/83 (53.0%) patients in the late phase. The mean time interval between the two phases was 12.7 s. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for hematoma progression of CTA spot sign were 48.1, 87.5, 65.0, 77.8, and 74.7%, respectively, in early phase and 92.6, 66.1, 56.8, 94.9, and 74.7%, respectively, in late phase. The CTA spot sign was significantly associated with ICH expansion in early (P < 0.001) and late (P < 0.00001) phases (Pearson's chi-square test). CONCLUSION A mere 10-s difference in scan timing could make a difference on prevalence and diagnostic performance of the CTA spot sign, suggesting a need for the standardization of the CTA protocol to generalize the approach for effective clinical application.
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Affiliation(s)
- Akio Tsukabe
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan,
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