CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage
CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage
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DOI：
10.1161/01.str.0000259633.59404.f3
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发表时间：
2007-04-01
期刊：
影响因子：
8.3
通讯作者：
Symons, Sean P.
中科院分区：
文献类型：
--
作者：
Wada, Ryan;Aviv, Richard I.;Symons, Sean P.
背景和目的：自发性脑出血（ICH）的发病率和死亡率与血肿进展相关。我们假设急性血肿内出现微小的增强灶（“斑点征”）与血肿扩张有关。方法：我们前瞻性研究了39例自发性脑出血患者，在症状出现后3小时内进行了计算机断层血管造影。扫描结果由3位读者审阅。根据有无斑点体征对患者进行分类。比较两组间的临床和影像学结果。在多变量分析中评估该标志的预测价值。结果：13例患者（33%）表现为31个增强灶。两组的基线临床变量相似。随访中11例（28%）患者出现血肿扩张。77%有血肿扩张的患者和4%无血肿扩张的患者表现为斑点征象（P < 0.0001）。扩张的敏感性、特异性、阳性预测值、阴性预测值和似然比分别为91%、89%、77%、96%和8.5。观察者间的一致性很高（kappa = 0.92 ~ 0.94）。斑点征患者平均体积变化较大（P = 0.008），外渗较常见（P = 0.0005），中位住院时间较长（P = 0.04），获得良好预后的患者较少（改良Rankin量表评分< 2），但后者无显著性差异（P = 0.16）。两组间脑积水（P = 1.00）、手术干预（P = 1.00）和死亡（P = 0.60）均无差异。在多元回归中，斑点标志独立预测血肿扩张（P = 0.0003）。结论：ct血管造影斑点征象与血肿进展的存在和程度有关。临床预后良好的患者较少，住院时间较长。需要进一步的研究来验证该体征预测临床结果的能力。
Background and Purpose-Morbidity and mortality in spontaneous intracerebral hemorrhage (ICH) are correlated with hematoma progression. We hypothesized that the presence of tiny, enhancing foci ("spot sign") within acute hematomas is associated with hematoma expansion.Methods-We prospectively studied 39 consecutive patients with spontaneous ICH by computed tomography angiography within 3 hours of symptom onset. Scans were reviewed by 3 readers. Patients were dichotomized according to the presence or absence of the spot sign. Clinical and radiological outcomes were compared between groups. The predictive value of this sign was assessed in a multivariate analysis.Results-Thirteen patients (33%) demonstrated 31 enhancing foci. Baseline clinical variables were similar in both groups. Hematoma expansion occurred in 11 patients (28%) on follow-up. Seventy-seven percent of patients with and 4% without hematoma expansion demonstrated the spot sign (P < 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio for expansion were 91%, 89%, 77%, 96%, and 8.5, respectively. Interobserver agreement was high (kappa = 0.92 to 0.94). In patients with the spot sign, mean volume change was greater (P = 0.008), extravasation more common (P = 0.0005), and median hospital stay longer (P = 0.04), and fewer patients achieved a good outcome (modified Rankin Scale score < 2), although the latter was not significant (P = 0.16). No differences in hydrocephalus (P = 1.00), surgical intervention (P = 1.00), or death (P = 0.60) were noted between groups. In multiple regression, the spot sign independently predicted hematoma expansion (P = 0.0003).Conclusions-The computed tomography angiography spot sign is associated with the presence and extent of hematoma progression. Fewer patients achieve a good clinical outcome and hospital stay was longer. Further studies are warranted to validate the ability of this sign to predict clinical outcomes.