Hotta Kazuko, Sorimachi Takatoshi, Osada Takahiro, Baba Tanefumi, Inoue Go, Atsumi Hideki, Ishizaka Hideo, Matsuda Minako, Hayashi Naokazu, Matsumae Mitsunori
Department of Neurosurgery, Tokai University School of Medicine, Shimokasuya 143, Isehara City, Kanagawa, 259-1193, Japan,
Acta Neurochir (Wien). 2014 May;156(5):911-7. doi: 10.1007/s00701-014-2019-7. Epub 2014 Mar 7.
Few studies have examined the risk of computed tomography angiography (CTA) during the acute phase of spontaneous intracerebral hemorrhage (ICH), while the benefits of CTA in ICH have been well-documented. The present study investigated both the benefits of identifying spot signs, which are supposed to indicate hematoma enlargement after admission, and risks of CTA performed during the acute phase of ICH.
We retrospectively assessed 323 consecutive patients with spontaneous ICHs admitted to our hospital between April 2009 and March 2012 and who underwent CTA on admission.
In 80 patients (24.7 %), spot signs were demonstrated on CTA source images. Multivariate analysis revealed two independent factors correlated with presence of the spot sign: age and hematoma volume (p < 0.05 each). The presence of spot sign was associated with unfavorable outcomes at discharge and hematoma growth after admission (p < 0.05 each). Adverse events related to CTA occurred in 17 patients (5.2 %), including transient renal dysfunction in 16 patients and allergy to contrast medium in one patient. All adverse events completely resolved within 1 week.
Presence of the spot sign indicated the possibility of hematoma growth and unfavorable outcomes. A small number of adverse events occurred in association with CTA, but without any permanent deficits. Given the potential benefits and risks, we believe that CTA performed at admission in all patients with ICH is beneficial to improve the outcomes.
很少有研究探讨自发性脑出血（ICH）急性期进行计算机断层血管造影（CTA）的风险，而CTA在ICH中的益处已有充分记录。本研究调查了识别斑点征（被认为提示入院后血肿扩大）的益处以及ICH急性期进行CTA的风险。
我们回顾性评估了2009年4月至2012年3月期间连续收治于我院且入院时接受CTA检查的323例自发性ICH患者。
80例患者（24.7%）的CTA源图像上显示有斑点征。多因素分析显示与斑点征存在相关的两个独立因素：年龄和血肿体积（各p<0.05）。斑点征的存在与出院时不良预后及入院后血肿增大相关（各p<0.05）。17例患者（5.2%）发生了与CTA相关的不良事件，包括16例短暂性肾功能不全和1例对造影剂过敏。所有不良事件在1周内完全缓解。
斑点征的存在提示血肿增大及不良预后的可能性。CTA相关的不良事件数量较少，且无任何永久性缺陷。鉴于潜在的益处和风险，我们认为对所有ICH患者入院时进行CTA有助于改善预后。
