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Published on: October 2, 2014
Negative spot sign in primary intracerebral hemorrhage: potential impact in reducing imaging
Javier M Romero1, Rania Hito2, Andre Dejam3
1Department of Radiology, Neuroradiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. jmromero@mgh.harvard.edu.
Insights
The CT angiography (CTA) spot sign reliably predicts intracerebral hemorrhage (ICH) expansion. Its absence has a high negative predictive value (NPV), especially in patients not on antithrombotic therapy, potentially reducing unnecessary follow-up imaging costs.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Intracerebral hemorrhage (ICH) is a severe stroke subtype with high mortality and healthcare costs.
- The CT angiography (CTA) spot sign indicates active bleeding and predicts hematoma expansion.
- Current protocols often involve repeat imaging to monitor for expansion.
Purpose of the Study:
- To determine the absolute negative predictive value (NPV) of the CTA spot sign for ICH expansion.
- To identify clinical characteristics of patients with ICH expansion despite a negative spot sign.
- To inform the development of cost-effective imaging protocols for ICH patients.
Main Methods:
- Retrospective evaluation of 204 patients with primary ICH undergoing CTA.
- Exclusion of patients with intraventricular hemorrhage (IVH).
- Analysis of clinical characteristics, antithrombotic use, and follow-up non-contrast CT (NCCT) scans for hematoma expansion in 123 patients.
Main Results:
- The overall NPV of the CTA spot sign for ICH expansion was 0.93.
- In patients without a spot sign, 7 out of 108 experienced expansion, with 6 on antithrombotic therapy.
- The NPV was significantly higher (0.98) in patients without antithrombotic therapy and no IVH.
Conclusions:
- The CTA spot sign is a highly reliable negative predictor of ICH expansion, particularly in patients not on antithrombotic therapy and without IVH.
- These findings support the potential to refine follow-up imaging strategies, reducing costs and patient exposure.
- Further research may validate these results for optimized ICH management protocols.
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.
