From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
Stroke. 2014 Jun;45(6):1833-5. doi: 10.1161/STROKEAHA.114.005276. Epub 2014 May 13.
Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy-related ICH.
Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location.
Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICH patients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01-5.71; P=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09-1.33, per 10 mL increase; P<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80-0.96, per hour; P=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87-8.51; P<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10-1.31, per 10 mL increase; P<0.001).
The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
在 CT 血管造影上呈现斑点征的颅内出血（ICH）患者血肿扩大和预后不良的风险增加。由于原发性 ICH 是慢性脑小血管病的急性表现，我们研究了不同的临床或影像学特征是否可以预测斑点征的存在，将 ICH 位置作为与小动脉病和脑淀粉样血管病相关 ICH 相关的替代指标。
纳入了有原发性 ICH 且有可用于检查的 CT 血管造影的患者。使用单变量和多变量回归，根据 ICH 位置对预测斑点征的因素进行分层评估。
符合条件的患者共 741 例，其中 335 例（45%）为深部 ICH，406 例（55%）为脑叶 ICH。至少有一个斑点征出现在 76 例（23%）深部 ICH 患者和 102 例（25%）脑叶 ICH 患者中。多变量回归分析显示，华法林（比值比 [OR]，2.42；95%置信区间 [CI]，1.01-5.71；P=0.04）、基线 ICH 体积（OR，1.20；95%CI，1.09-1.33，每增加 10mL；P<0.001）和从症状发作到 CT 血管造影的时间（OR，0.89；95%CI，0.80-0.96，每小时增加 1 小时；P=0.009）与深部 ICH 的斑点征有关。脑叶 ICH 斑点征的预测因素为华法林（OR，3.95；95%CI，1.87-8.51；P<0.001）和基线 ICH 体积（OR，1.20；95%CI，1.10-1.31，每增加 10mL；P<0.001）。
与斑点征最密切相关的因素在深部和脑叶 ICH 之间是共同的，这表明在不同的慢性小血管疾病背景下出现的急性出血过程具有共同的特点。
