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Published on: October 15, 2021
Do Intracerebral Hemorrhage Nonexpanders Actually Expand Into the Ventricular Space?
Dar Dowlatshahi1, Anirudda Deshpande2, Richard I Aviv2
1From the Department of Diagnostic Imaging, Neuroradiology Section, Ottawa Hospital Research Institute (C.L.) and Division of Neurology, Department of Medicine (D.D.), University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada (D.D.); Vinayaka Neuro Multispecialty Centre, Warangal, India (A.D.); Division of Neuroradiology (R.I.A.) and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Canada; Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (D.R.-L., C.A.M.); Department of Neurology, Doctor Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain (Y.S.B.); Department of Neurology, Elblandklinikum Meissen Academic Teaching Hospital of the Technische University, Dresden, Germany (I.D.); Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.K.); Department of Experimental and Clinical Pharmacology, Warsaw, Poland (A.K.); Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada (J.-M.B.); Department of Neurology, Dalhousie University, Halifax, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi (V.P., R.B.); AMRI Neurosciences Centre, Mukundapur, Kolkata, India (J.R.); Department of Neurology, Boston Medical Center, MA (C.S.K.); and Department of Clinical Neurosciences, Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., A.M.D.). ddowlat@toh.ca.
The spot sign predicts hematoma expansion in patients with intracerebral hemorrhage (ICH). Including intraventricular hemorrhage (IVH) expansion in the definition did not improve the spot sign's predictive performance.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- The spot sign on computed tomographic angiography is a marker for hematoma expansion in intracerebral hemorrhage (ICH).
- Its predictive value is limited by modest sensitivity and positive predictive value.
- Hematoma expansion may be missed if it decompresses into the ventricular space, causing intraventricular hemorrhage (IVH).
Purpose of the Study:
- To determine if revising hematoma expansion definitions to include IVH expansion improves the spot sign's predictive performance.
- To identify the proportion of ICH non-expanders with IVH expansion.
- To assess the rate of IVH expansion in false-positive spot sign cases.
Main Methods:
- Analysis of patient data from the multicenter PREDICT ICH spot sign study.
- Definition of hematoma expansion: ≥6 mL or ≥33% ICH expansion or >2 mL IVH expansion.
- Comparison of spot sign performance using the revised definition versus the conventional definition via receiver operating curve analysis.
Main Results:
- Of 311 patients, 213 were classified as non-expanders by the conventional definition.
- Only 6.1% of non-expanders showed ≥2 mL IVH expansion.
- The area under the curve for the spot sign was 0.65, which did not significantly change when IVH expansion was included (0.66).
Conclusions:
- While IVH expansion occurs in a small subset of ICH non-expanders, it does not significantly improve the spot sign's predictive capability.
- The inclusion of IVH expansion in the definition of hematoma expansion does not enhance the spot sign's performance.
- The spot sign's predictive performance for hematoma expansion remains limited, even with revised definitions.
