Emergency Radiology

, Volume 19, Issue 3, pp 195–202 | Cite as

Spot sign score predicts rapid bleeding in spontaneous intracerebral hemorrhage

  • Javier M. Romero
  • Jeremy J. Heit
  • Josser E. Delgado Almandoz
  • Joshua N. Goldstein
  • Jingjing Lu
  • Elkan Halpern
  • Steven M. Greenberg
  • Jonathan Rosand
  • R. Gilberto Gonzalez
Original Article


This study was conducted to determine whether spot sign score correlates with average rate of hematoma expansion and whether average rate of expansion predicts in-hospital mortality and clinical outcome in spontaneous intracerebral hemorrhage (ICH). The study included 367 patients presenting to the Emergency Department (ED) from January 1, 2000 to December 31, 2008 with nontraumatic ICH. All received noncontrast computed tomography (NCCT) of the head and multidetector CT angiography (MDCTA) on presentation to the ED and a follow-up NCCT within 48 h. Imaging was used to determine the hematoma location and volume, average rate of expansion, and spot sign score. Primary outcome measures included in-hospital mortality and clinical outcome based on modified Rankin Scale at 3 months or at discharge. Regression analysis was performed to correlate spot sign score and average rate of hematoma expansion. ICH expansion was identified in 194 of 367 patients (53%). In a multivariate analysis, rate of ICH expansion predicted mortality (hazard ratio 1.1, CI 1.08–1.12, p < 0.0001). Patients who expired had an average rate of ICH expansion of 2.8 ml/h compared to 0.2 ml/h in survivors. Spot sign score on presentation to the ED correlated with the average rate of hematoma expansion. Average rate of hematoma expansion predicts mortality in spontaneous ICH. Spot sign score on presentation correlates with rate of expansion, supporting the hypothesis that high spot sign scores likely reflect active bleeding in acute ICH.


Intracerebral hemorrhage CT angiography Mortality Emergency radiolgy Hematoma expansion NCCT 



Intracerebral hemorrhage


Intraventricular hemorrhage


Noncontrast computed tomography


Multidetector CT angiography


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Copyright information

© Am Soc Emergency Radiol 2012

Authors and Affiliations

  • Javier M. Romero
    • 1
  • Jeremy J. Heit
    • 1
  • Josser E. Delgado Almandoz
    • 2
  • Joshua N. Goldstein
    • 3
  • Jingjing Lu
    • 1
  • Elkan Halpern
    • 1
  • Steven M. Greenberg
    • 4
  • Jonathan Rosand
    • 4
  • R. Gilberto Gonzalez
    • 1
  1. 1.Division of Neuroradiology, Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Interventional NeuroradiologyAbbott Northwestern HospitalMinneapolisUSA
  3. 3.Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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