Department of Radiology, Copenhagen University Hospital - Bispebjerg and Copenhagen Stroke Research Centre, Copenhagen, Denmark.
Cerebrovasc Dis. 2014;37(3):164-70. doi: 10.1159/000357397. Epub 2014 Feb 13.
A spot sign on computed tomography angiography (CTA) is a potentially strong predictor of poor outcome on ultra-early radiological imaging. The aim of this study was to assess the spot sign as a predictor of functional outcome at 3 months as well as long-term mortality, with a focus on the ability to identify patients with a spontaneous, acceptable outcome.
In a prospective, consecutive single-centre registry of acute stroke patients, we investigated patients with spontaneous intracerebral haemorrhage (ICH) admitted within 4.5 h after symptom onset from April 2009 to January 2013. The standard work-up in our centre included CTA for spot sign status, unless a contraindication was present. Modified Rankin Scale (mRS) scores were assessed at 3 months in the outpatient clinic or by telephone interviews. Long-term mortality was assessed by electronic chart follow-up for up to 1,500 days.
Of the 128 patients, 37 (28.9%) had a spot sign on admission CTA. The presence of a spot sign was associated with larger median admission haematoma volume [38.0 ml (IQR 18.0-78.0) vs. 12.0 ml (5.0-24.0); p<0.0001] and higher median National Institutes of Health Stroke Scale score [19 (IQR 12-23) vs. 12 (6-16); p<0.0001]. Three months after stroke, the median functional outcome was considerably better in patients without spot sign [mRS score 3 (IQR 2-4) vs. 6 (4-6); p<0.0001]. The absence of a spot sign showed a sensitivity and specificity for good outcome (mRS scores 0-2) of 0.91 and 0.36, respectively. The presence of a spot sign was, in multivariate models, an independent inverse predictor of good 3-month outcome (OR 0.17; 95% CI: 0.03-0.88) as well as a prominent independent predictor of poor 3-month outcome (mRS scores 5-6; OR 3.40; 95% CI: 1.10-10.5) and death during follow-up (HR 3.04; 95% CI: 1.45-6.34). Patients with a spot sign surviving the acute phase had long-term survival comparable to patients with no spot sign.
The absence or presence of a spot sign is a reliable ultra-early predictor of long-term mortality and functional outcome in patients with spontaneous ICH.
计算机断层血管造影（CTA）上的斑点征是超早期影像学预后不良的一个潜在强预测因子。本研究的目的是评估斑点征作为 3 个月功能结局的预测因子，以及长期死亡率，重点是识别自发性、可接受结局的患者的能力。
在 2009 年 4 月至 2013 年 1 月期间，我们在急性卒中患者的前瞻性连续单中心登记处，对症状发作后 4.5 小时内入院的自发性脑出血（ICH）患者进行了研究。我们中心的标准检查包括 CTA 以确定斑点征状态，除非存在禁忌症。3 个月时，通过门诊或电话访谈评估改良 Rankin 量表（mRS）评分。通过电子病历随访，对长达 1500 天的长期死亡率进行评估。
128 例患者中，37 例（28.9%）入院 CTA 时存在斑点征。斑点征的存在与更大的中位数入院血肿体积相关[38.0 ml（IQR 18.0-78.0）vs. 12.0 ml（5.0-24.0）；p<0.0001]和更高的中位数国立卫生研究院卒中量表评分[19（IQR 12-23）vs. 12（6-16）；p<0.0001]。卒中后 3 个月，无斑点征患者的中位功能结局明显更好[mRS 评分 3（IQR 2-4）vs. 6（4-6）；p<0.0001]。无斑点征对良好结局（mRS 评分 0-2）的灵敏度和特异性分别为 0.91 和 0.36。多变量模型中，斑点征的存在是 3 个月良好结局的独立负预测因子（OR 0.17；95%CI：0.03-0.88），也是 3 个月不良结局（mRS 评分 5-6；OR 3.40；95%CI：1.10-10.5）和随访期间死亡的显著独立预测因子（HR 3.04；95%CI：1.45-6.34）。在急性期存活的有斑点征患者的长期生存率与无斑点征患者相当。
自发性 ICH 患者斑点征的有无是长期死亡率和功能结局的可靠超早期预测因子。
