Eliminating vascular interference from the Spot Sign contributes to predicting hematoma expansion in individuals with spontaneous cerebral hemorrhages

  • Pan Yi
  • Min Xu
  • Pin Chen
  • Yu Luo
  • Dongdong Wang
  • Hui Wang
  • Cunzu WangEmail author
Original article


The computed tomography angiography (CTA) Spot Sign is an effective means of predicting hematoma expansion (HE) in the context of spontaneous intracerebral hemorrhage (ICH). We investigated whether continuous CTA source images could differentiate the Spot Sign and blood vessels in the hematoma, and whether it would improve Spot Sign accuracy as an HE predictor. We screened for the presence of CTA Spot Sign in individuals affected by spontaneous ICH within 24 h of symptom development. Based on our findings, we determined the sensitivity, specificity, and positive/negative predictive values of this sign as a predictor of HE both on its own and following the exclusion of blood vessels. In addition, a receiver-operating characteristic approach was used to assess the accuracy of Spot Sign with and without elimination of vascular interference. A total of 265 patients were included in this study. The Spot Sign was observed in 100 patients, including in 29 patients wherein it was confirmed to be blood vessels as determined based upon continuous CTA source images. With respect to predicting HE, Spot Sign sensitivity, specificity, positive predictive values, and negative predictive values were 57%, 71%, 48% and 78%, respectively. Following the exclusion of blood vessels, these values were 57%, 87%, 68% and 81%, respectively. Spot Sign area under the curve after excluding blood vessels was 0.718, which was higher than that of the Spot Sign (0.638). After continuous CTA, source images are used to exclude blood vessels in the hematoma, the Spot Sign is thus more accurate in predicting HE.


Spontaneous intracerebral hemorrhage Hematoma expansion Spot Sign Computed tomography angiography 



The largest acknowledgment goes to the patients who participated in this study and as well as to everyone who contributed to this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • Pan Yi
    • 1
  • Min Xu
    • 2
  • Pin Chen
    • 3
  • Yu Luo
    • 1
  • Dongdong Wang
    • 1
  • Hui Wang
    • 1
  • Cunzu Wang
    • 3
    Email author
  1. 1.Dalian Medical UniversityDalianChina
  2. 2.Department of Neurosurgery, Kunshan Hospital of Traditional Chinese MedicineAffiliated Hospital of Nanjing University of Chinese MedicineKunshanChina
  3. 3.Department of NeurosurgeryNorthern Jiangsu People’s HospitalYangzhouChina

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