Predicting Intracerebral Hemorrhage Growth With the Spot Sign: The Effect of Onset-to-Scan Time.

作者信息

Dowlatshahi Dar, Brouwers H Bart, Demchuk Andrew M, Hill Michael D, Aviv Richard I, Ufholz Lee-Anne, Reaume Michael, Wintermark Max, Hemphill J Claude, Murai Yasuo, Wang Yongjun, Zhao Xingquan, Wang Yilong, Li Na, Sorimachi Takatoshi, Matsumae Mitsunori, Steiner Thorsten, Rizos Timolaos, Greenberg Steven M, Romero Javier M, Rosand Jonathan, Goldstein Joshua N, Sharma Mukul

机构信息

From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).

出版信息

Stroke. 2016 Mar;47(3):695-700. doi: 10.1161/STROKEAHA.115.012012. Epub 2016 Feb 4.

DOI:10.1161/STROKEAHA.115.012012

PMID:26846857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4766058/

Abstract

BACKGROUND AND PURPOSE

Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign.

METHODS

We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates.

RESULTS

Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours (P<0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased (P=0.004), with positive predictive values decreasing from 53% to 33%.

CONCLUSIONS

The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.

摘要