Authors: Andrea Morotti Michael J Jessel H Bart Brouwers Guido J Falcone Kristin Schwab Alison M Ayres Anastasia Vashkevich Christopher D Anderson Anand Viswanathan Steven M Greenberg M Edip Gurol Javier M Romero Jonathan Rosand Joshua N Goldstein
Publish Date: 2016/01/12
Volume: 25, Issue: 1, Pages: 79-85
Abstract
The computed tomography angiography CTA spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage ICH but patients with brainstem ICH have typically been excluded from the analyses We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage PPHWe performed a retrospective analysis of PPH cases obtained from a prospectively collected cohort of consecutive ICH patients who underwent CTA CTA firstpass readings for spot sign presence were analyzed by two trained readers Baseline and followup hematoma volumes on noncontrast CT scans were assessed by semiautomated computerassisted volumetric analysis Sensitivity specificity positive predictive value PPV negative predictive value NPV positive and negative likelihood ratio and accuracy of spot sign for prediction of inhospital mortality were calculated49 subjects met the inclusion criteria of whom 11 224 showed a spot sign Inhospital mortality was higher in spot signpositive versus spot signnegative subjects 909 vs 474 p = 0020 Spot sign showed excellent specificity 95 and PPV 91 in predicting inhospital mortality Absolute hematoma growth defined as parenchymal and intraventricular hematoma expansion of any amount was significantly higher in spot signpositive versus spot signnegative subjects 1372 ± 2093 vs 376 ± 855 mL p = 0045This study was supported by the following awards from the NINDS 5R01NS073344 K23AG02872605 K23 NS086873 R01NS059727 None of the funding entities had any involvement in study design data collection analysis and interpretation writing of the manuscript or decision to submit the study for publicationAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
Keywords: