“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage
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To evaluate the association between dynamic progressive enhancing foci (“dynamic spot sign”) in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion.
One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed.
Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386–590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123–1295.488), P < 0.0001.
The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign.
• It is important to identify potential progression of spontaneous intracerebral haemorrhage.
• Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion.
• The CTP dynamic spot sign may be present throughout arterial to venous phase imaging.
• The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.
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- “Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage
Volume 23, Issue 7 , pp 1846-1854
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- Computed tomography
- Source images
- Intracerebral haemorrhage
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- Author Affiliations
- 1. Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 2. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China