Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score.
Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion: the spot sign score.
复制标题
脑内出血的计算机断层扫描血管造影仪的系统表征确定血肿膨胀风险最高的患者：点标志评分。
DOI：
10.1161/strokeaha.109.554667
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发表时间：
2009-09
期刊：
影响因子：
8.3
通讯作者：
Romero JM
中科院分区：
文献类型：
--
作者：
Delgado Almandoz JE;Yoo AJ;Stone MJ;Schaefer PW;Goldstein JN;Rosand J;Oleinik A;Lev MH;Gonzalez RG;Romero JM
在CT血管成像上，活动性对比剂外渗(斑点征)的存在已被认为是脑出血患者血肿扩大的预测指标。我们的目标是系统地描述斑点征，以确定最能预测血肿扩大的特征，并构建斑点征评分系统。我们回顾了9年来在急诊科就诊的所有原发性脑出血患者的CT血管造影，并在基线CT血管造影后48小时内进行了头部CT平扫。三位神经放射科医生回顾了CT血管造影，并根据严格的放射学标准确定了斑点征象的存在和特征。通过计算机辅助容量分析确定基线和随访的脑内出血量。在367例CT血管造影中，71例(19%)发现斑点征，其中6例为延迟性斑点征(8%)。任何斑点征的存在都会增加显著血肿扩大的风险(69%，OR=92，P<；0.0001)。在检查的斑点征特征中，≥3斑点征、最大轴向直径≥5 mm和最大衰减≥180Hounsfield单位是显著血肿扩大的独立预测因素，并随后被用来构建斑点征评分。在多变量分析中，斑点征积分是显著血肿扩大的最强预测因子，与发病至CT血管造影评估的时间无关。斑点征评分预示着原发性脑出血有明显的血肿扩大。如果在其他数据集中得到验证，它可以用于选择患者进行早期止血治疗。
The presence of active contrast extravasation (the spot sign) on computed tomography (CT) angiography has been recognized as a predictor of hematoma expansion in patients with intracerebral hemorrhage. We aim to systematically characterize the spot sign to identify features that are most predictive of hematoma expansion and construct a spot sign scoring system. We retrospectively reviewed CT angiograms performed in all patients who presented to our emergency department over a 9-year period with primary intracerebral hemorrhage and had a follow-up noncontrast head CT within 48 hours of the baseline CT angiogram. Three neuroradiologists reviewed the CT angiograms and determined the presence and characteristics of spot signs according to strict radiological criteria. Baseline and follow-up intracerebral hemorrhage volumes were determined by computer-assisted volumetric analysis. We identified spot signs in 71 of 367 CT angiograms (19%), 6 of which were delayed spot signs (8%). The presence of any spot sign increased the risk of significant hematoma expansion (69%, OR=92, P<0.0001). Among the spot sign characteristics examined, the presence of ≥3 spot signs, a maximum axial dimension ≥5 mm, and maximum attenuation ≥180 Hounsfield units were independent predictors of significant hematoma expansion, and these were subsequently used to construct the spot sign score. In multivariate analysis, the spot sign score was the strongest predictor of significant hematoma expansion, independent of time from ictus to CT angiogram evaluation. The spot sign score predicts significant hematoma expansion in primary intracerebral hemorrhage. If validated in other data sets, it could be used to select patients for early hemostatic therapy.