Dowlatshahi Dar, Deshpande Anirudda, Aviv Richard I, Rodriguez-Luna David, Molina Carlos A, Blas Yolanda Silva, Dzialowski Imanuel, Kobayashi Adam, Boulanger Jean-Martin, Lum Cheemun, Gubitz Gordon J, Padma Vasantha, Roy Jayanta, Kase Carlos S, Bhatia Rohit, Hill Michael D, Demchuk Andrew M
From the Department of Diagnostic Imaging, Neuroradiology Section, Ottawa Hospital Research Institute (C.L.) and Division of Neurology, Department of Medicine (D.D.), University of Ottawa, Canada; Ottawa Hospital Research Institute, Canada (D.D.); Vinayaka Neuro Multispecialty Centre, Warangal, India (A.D.); Division of Neuroradiology (R.I.A.) and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Canada; Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (D.R.-L., C.A.M.); Department of Neurology, Doctor Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain (Y.S.B.); Department of Neurology, Elblandklinikum Meissen Academic Teaching Hospital of the Technische University, Dresden, Germany (I.D.); Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.K.); Department of Experimental and Clinical Pharmacology, Warsaw, Poland (A.K.); Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada (J.-M.B.); Department of Neurology, Dalhousie University, Halifax, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi (V.P., R.B.); AMRI Neurosciences Centre, Mukundapur, Kolkata, India (J.R.); Department of Neurology, Boston Medical Center, MA (C.S.K.); and Department of Clinical Neurosciences, Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Canada (M.D.H., A.M.D.).
Stroke. 2018 Jan;49(1):201-203. doi: 10.1161/STROKEAHA.117.018716. Epub 2017 Nov 22.
The computed tomographic angiography spot sign as a predictor of hematoma expansion is limited by its modest sensitivity and positive predictive value. It is possible that hematoma expansion in spot-positive patients is missed because of decompression of intracerebral hemorrhage (ICH) into the ventricular space. We hypothesized that revising hematoma expansion definitions to include intraventricular hemorrhage (IVH) expansion will improve the predictive performance of the spot sign. Our objectives were to determine the proportion of ICH nonexpanders who actually have IVH expansion, determine the proportion of false-positive spot signs that have IVH expansion, and compare the known predictive performance of the spot sign to a revised definition incorporating IVH expansion.
We analyzed patients from the multicenter PREDICT ICH spot sign study. We defined hematoma expansion as ≥6 mL or ≥33% ICH expansion or >2 mL IVH expansion and compared spot sign performance using this revised definition with the conventional 6 mL/33% definition using receiver operating curve analysis.
Of 311 patients, 213 did not meet the 6-mL/33% expansion definition (nonexpanders). Only 13 of 213 (6.1%) nonexpanders had ≥2 mL IVH expansion. Of the false-positive spot signs, 4 of 40 (10%) had >2 mL ventricular expansion. The area under the curve for spot sign to predict significant ICH expansion was 0.65 (95% confidence interval, 0.58-0.72), which was no different than when IVH expansion was added to the definition (area under the curve, 0.66; 95% confidence interval, 0.58-0.71).
Although IVH expansion does indeed occur in a minority of ICH nonexpanders, its inclusion into a revised hematoma expansion definition does not alter the predictive performance of the spot sign.
计算机断层血管造影斑点征作为血肿扩大的预测指标，其敏感性和阳性预测值有限。斑点征阳性患者的血肿扩大可能因脑出血（ICH）破入脑室而被漏诊。我们假设修订血肿扩大的定义以纳入脑室内出血（IVH）扩大，将提高斑点征的预测性能。我们的目的是确定实际发生IVH扩大的ICH未扩大患者的比例，确定存在IVH扩大的假阳性斑点征的比例，并将斑点征已知的预测性能与纳入IVH扩大的修订定义进行比较。
我们分析了多中心预测ICH斑点征研究中的患者。我们将血肿扩大定义为≥6 mL或ICH扩大≥33%或IVH扩大>2 mL，并使用受试者工作特征曲线分析，将使用此修订定义的斑点征性能与传统的6 mL/33%定义进行比较。
在311例患者中，213例未达到6 mL/33%的扩大定义（未扩大者）。213例未扩大者中只有13例（6.1%）有≥2 mL的IVH扩大。在假阳性斑点征中，40例中有4例（10%）有>2 mL的脑室扩大。斑点征预测显著ICH扩大的曲线下面积为0.65（95%置信区间，0.58 - 0.72），与将IVH扩大纳入定义时相比无差异（曲线下面积，0.66；95%置信区间，0.58 - 0.71）。
虽然少数ICH未扩大者确实会发生IVH扩大，但将其纳入修订的血肿扩大定义并不会改变斑点征的预测性能。
