Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.
J Neurointerv Surg. 2012 Nov;4(6):442-7. doi: 10.1136/neurintsurg-2011-010061. Epub 2011 Oct 15.
The presence of active contrast extravasation during CT angiography, the spot sign, is a potent predictor of in-hospital mortality in patients with primary intracerebral hemorrhage (ICH). However, its predictive value in patients with ICH due to a vascular abnormality, secondary ICH (SICH), is unknown. The aim of this study was to determine the clinical and radiological predictors of a spot sign and in-hospital mortality in patients with SICH.
Two experienced readers independently reviewed CT angiograms performed on 215 consecutive patients presenting to the emergency department with SICH over a 10-year period to assess the presence of spot signs according to strict radiological criteria. Differences in reader interpretation were resolved by consensus. Medical records were reviewed for baseline clinical characteristics and in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to determine the clinical and radiological predictors of a spot sign and in-hospital mortality in patients with SICH.
Spot signs were identified in 31 of 215 patients with SICH (14.4%), four of which were delayed spot signs (12.9%). Spot signs were most common in patients with arteriovenous fistulas (42%), Moyamoya (40%), elevated admission blood glucose (23%) and large intraventricular hemorrhage volumes (29%). Spot signs were most predictive of in-hospital mortality in patients with aneurysms of the anterior cerebral artery (100%) and anterior communicating artery (75%). In univariate analysis, the presence of a spot sign significantly increased the risk of in-hospital mortality in patients with SICH (38.7%, OR 2.2, 95% CI 1.0 to 4.9, p=0.0497). However, in multivariate logistic regression analysis the admission Glasgow Coma Scale was the only independent predictor of in-hospital mortality in patients with SICH (OR 2.8, 95% CI 1.6 to 5.1, p=0.0004).
The spot sign identifies patients with SICH at increased risk of in-hospital mortality. However, the admission Glasgow Coma Scale was the only independent predictor of in-hospital mortality in this cohort of patients with SICH.
CT 血管造影中出现活性对比外渗（即斑点征）是原发性脑出血（ICH）患者住院期间死亡率的有力预测指标。然而，其在血管异常引起的 ICH（继发性 ICH，SICH）患者中的预测价值尚不清楚。本研究旨在确定 SICH 患者斑点征和住院期间死亡率的临床和影像学预测因素。
两名经验丰富的阅片者独立回顾了在过去 10 年期间，因 SICH 就诊于急诊科的 215 例连续患者的 CT 血管造影图像，根据严格的影像学标准评估斑点征的存在。通过共识解决了阅片者解释的差异。查阅病历以了解基线临床特征和住院期间死亡率。对 SICH 患者斑点征和住院期间死亡率的临床和影像学预测因素进行单因素和多因素逻辑回归分析。
在 215 例 SICH 患者中，有 31 例（14.4%）存在斑点征，其中 4 例为延迟斑点征（12.9%）。斑点征最常见于动静脉瘘（42%）、烟雾病（40%）、入院时血糖升高（23%）和较大的脑室内出血量（29%）患者中。斑点征在前交通动脉动脉瘤（100%）和前交通动脉动脉瘤（75%）患者中对住院期间死亡率的预测最为显著。单因素分析显示，SICH 患者斑点征的存在显著增加了住院期间死亡率的风险（38.7%，OR 2.2，95%CI 1.0 至 4.9，p=0.0497）。然而，多因素逻辑回归分析显示，入院格拉斯哥昏迷量表评分是 SICH 患者住院期间死亡率的唯一独立预测因素（OR 2.8，95%CI 1.6 至 5.1，p=0.0004）。
斑点征可识别 SICH 患者住院期间死亡率较高的风险。然而，入院格拉斯哥昏迷量表评分是该队列 SICH 患者住院期间死亡率的唯一独立预测因素。
