PT  - JOURNAL ARTICLE
AU  - Horn, MacKenzie
AU  - Teleg, Ericka
AU  - Tanaka, Koji
AU  - Al Sultan, Abdulaziz
AU  - Kasickova, Linda
AU  - Ohara, Tomoyuki
AU  - Ojha, Piyush
AU  - Wasyliw, Sanchea
AU  - Marzoughi, Sina
AU  - Banerjee, Ankur
AU  - Kulkarni, Girish
AU  - Horn, Kennedy
AU  - Bobyn, Amy
AU  - Neweduk, Anneliese
AU  - Singh, Nishita
AU  - Qiu, Wu
AU  - Rodriguez-Luna, David
AU  - Dowlatshahi, Dar
AU  - Goyal, Mayank
AU  - Menon, Bijoy K.
AU  - Demchuk, Andrew M.
TI  - Timing of Spot Sign Appearance, Spot Sign Volume, and Leakage Rate among Phases of Multiphase CTA Predict Intracerebral Hemorrhage Growth
AID  - 10.3174/ajnr.A8254
DP  - 2024 Jun 01
TA  - American Journal of Neuroradiology
PG  - 693--700
VI  - 45
IP  - 6
4099  - http://www.ajnr.org/content/45/6/693.short
4100  - http://www.ajnr.org/content/45/6/693.full
SO  - Am. J. Neuroradiol.2024 Jun 01; 45
AB  - 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.ICHintracerebral hemorrhagemCTAmultiphase CTA