CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage.
CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage.
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DOI：
10.1007/s12028-016-0241-2
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发表时间：
2016-08
影响因子：
3.5
通讯作者：
Goldstein JN
中科院分区：
文献类型：
--
作者：
Morotti A;Jessel MJ;Brouwers HB;Falcone GJ;Schwab K;Ayres AM;Vashkevich A;Anderson CD;Viswanathan A;Greenberg SM;Gurol ME;Romero JM;Rosand J;Goldstein JN
计算机断层扫描血管造影 (CTA) 斑征是血肿扩张和幕上脑出血 (ICH) 预后不良的有效预测因子，但脑干 ICH 患者通常被排除在分析之外。我们调查了原发性脑桥出血（PPH）患者的点征频率及其与血肿扩张和预后的关系。我们对前瞻性收集的连续 ICH 患者队列中获得的 PPH 病例进行了回顾性分析，这些患者接受了 CTA。两名训练有素的阅读器对点标志存在的 CTA 首次通过读数进行了分析。通过半自动计算机辅助体积分析评估非对比 CT 扫描的基线和随访血肿体积。计算院内死亡率预测的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性和阴性似然比以及点征准确性。 49 名受试者符合纳入标准，其中 11 名（22.4%）出现斑点征。点征阳性受试者的院内死亡率高于阴性受试者（90.9% vs 47.4%，p=0.020）。 Spot Sign 在预测院内死亡率方面表现出出色的特异性 (95%) 和 PPV (91%)。绝对血肿生长（定义为任意数量的实质和脑室内血肿扩张）在点征阳性受试者中显着高于阴性受试者（13.72 ± 20.93 vs 3.76 ± 8.55 mL，p = 0.045）。与幕上 ICH 一样，CTA 斑点征是常见发现，并且与 PPH 中血肿扩大和死亡率较高的风险相关。该标志物可以帮助临床医生进行预后分层。
The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage (ICH), but patients with brainstem ICH have typically been excluded from analyses. We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage (PPH). We performed a retrospective analysis of PPH cases obtained from a prospectively collected cohort of consecutive ICH patients who underwent CTA. CTA first pass readings for spot sign presence were analyzed by two trained readers. Baseline and follow-up hematoma volumes on non-contrast CT scans were assessed by semi-automated computer-assisted volumetric analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio and accuracy of spot sign for prediction of in-hospital mortality were calculated. 49 subjects met the inclusion criteria of whom 11 (22.4%) showed a spot sign. In-hospital mortality was higher in spot sign positive versus negative subjects (90.9% vs 47.4%, p=0.020). Spot sign showed excellent specificity (95%) and PPV (91%) in predicting in-hospital mortality. Absolute hematoma growth, defined as parenchymal and intraventricular hematoma expansion of any amount, was significantly higher in spot sign positive versus negative subjects (13.72 ± 20.93 vs 3.76 ± 8.55 mL, p=0.045). As with supratentorial ICH, the CTA spot sign is a common finding and is associated with higher risk of hematoma expansion and mortality in PPH. This marker may assist clinicians in prognostic stratification.