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Updated: Jan 9, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Contrast Extravasation on Computed Tomography Angiography as a Predictor of Hematoma Expansion and Outcomes in
Alhanouf H Hatim1, Danah K Kabrah2, Mohamed E Hassan3
1Radiology, King Fahad General Hospital, Jeddah, SAU.
Background:
Contrast extravasation ("spot sign") on computed tomography angiography (CTA) is a key imaging biomarker of active bleeding in spontaneous intracerebral hemorrhage (ICH) and is strongly associated with hematoma expansion and poor outcomes. However, data from Middle Eastern populations remains limited. This study aimed to identify the clinical and radiologic predictors of contrast extravasation and to assess its association with hematoma expansion and functional outcomes among patients with spontaneous ICH.
Materials And Methods:
We conducted a multicenter retrospective cohort study of adult patients with spontaneous ICH who underwent non-contrast head CT and CTA at presentation between January 2020 and December 2024. Baseline demographic, clinical, and imaging data were collected. Contrast extravasation was defined as a focus of hyperattenuation ≥120 HU within the hematoma on CTA, discontinuous from normal vessels. The primary outcome was the presence of contrast extravasation. Secondary outcomes included hematoma expansion on follow-up CT and poor functional outcome at 90 days. Independent predictors were identified using multivariable logistic regression.
Results:
A total of 450 patients (mean age 66.1 ± 12.0 years; 58.0% men) were included. Contrast extravasation was observed in 141 patients (31.3%). Independent predictors of contrast extravasation were larger baseline hematoma volume (adjusted odds ratio (aOR) 1.32 per 10-mL increase; 95% CI, 1.18-1.47; P < 0.001), higher systolic blood pressure (SBP) (aOR 1.19 per 10-mm Hg increase; 95% CI, 1.05-1.35; P = 0.006), and anticoagulant use (aOR 2.42; 95% CI, 1.50-3.90; P < 0.001). Contrast extravasation was strongly associated with hematoma expansion (aOR 2.94; 95% CI, 1.82-4.75; P < 0.001) and poor 90-day functional outcome (aOR 1.68; 95% CI, 1.06-2.66; P = 0.028). In-hospital mortality was higher among spot-positive patients (18.0% vs. 6.0%).
Conclusions:
Contrast extravasation on CTA was present in nearly one-third of patients with spontaneous ICH in this Saudi multicenter cohort and independently predicted hematoma expansion and unfavorable outcomes. Larger hematoma volume, elevated SBP, and anticoagulant therapy were the strongest predictors. Routine assessment for the spot sign during acute ICH imaging may enhance early risk stratification and guide targeted management strategies.
