Neuroradiology Department, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
Neuroradiology Department, Beijing Neurosurgical Institute, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
Eur Radiol. 2018 Oct;28(10):4343-4349. doi: 10.1007/s00330-018-5415-1. Epub 2018 Apr 19.
The computed tomography angiography (CTA) spot sign is a validated predictor of haematoma expansion (HE) in spontaneous intracerebral haemorrhage (SICH). We investigated whether defining the iodine concentration (IC) inside the spot sign and the haematoma on Gemstone spectral imaging (GSI) would improve its sensitivity and specificity for predicting HE.
From 2014 to 2016, we prospectively enrolled 65 SICH patients who underwent single-phase spectral CTA within 6 h. Logistic regression was performed to assess the risk factors for HE. The predictive performance of individual spot sign characteristics was examined via receiver operating characteristic (ROC) analysis.
The spot sign was detected in 46.1% (30/65) of patients. ROC analysis indicated that IC inside the spot sign had the greatest area under the ROC curve for HE (0.858; 95% confidence interval, 0.727-0.989; p = 0.003). Multivariate analysis found that spot sign with higher IC (i.e. IC > 7.82 100 μg/ml) was an independent predictor of HE (odds ratio = 34.27; 95% confidence interval, 5.608-209.41; p < 0.001) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.81, 0.75, 0.90 and 0.60, respectively; while the spot sign showed sensitivity, specificity, PPV and NPV of 0.81, 0.79, 0.73 and 0.86. Logistic regression analysis indicated that the IC in haematomas was independently associated with HE (odds ratio = 1.525; 95% confidence interval, 1.041-2.235; p = 0.030).
ICs in haematoma and in spot sign were all independently associated with HE. IC analysis in spectral imaging may help to identify SICH patients for targeted haemostatic therapy.
• Iodine concentration in spot sign and haematoma can predict haematoma expansion • Spectral imaging could measure the IC inside the spot sign and haematoma • IC in spot sign improved the positive predictive value (PPV) cf. CTA.
计算机断层血管造影术（CTA）斑点征是自发性脑出血（SICH）血肿扩大（HE）的有效预测因子。我们研究了在宝石能谱成像（GSI）中定义斑点征内碘浓度（IC）和血肿内 IC 是否可以提高其预测 HE 的灵敏度和特异性。
2014 年至 2016 年，我们前瞻性纳入了 65 例发病 6 小时内行单相能谱 CTA 的 SICH 患者。采用逻辑回归分析评估 HE 的危险因素。通过受试者工作特征（ROC）曲线分析评估单个斑点征特征的预测性能。
46.1%（30/65）的患者检测到斑点征。ROC 分析表明，斑点征内 IC 对 HE 的 ROC 曲线下面积最大（0.858；95%置信区间，0.727-0.989；p=0.003）。多变量分析发现，IC 较高的斑点征（即 IC＞7.82×100μg/ml）是 HE 的独立预测因子（优势比=34.27；95%置信区间，5.608-209.41；p＜0.001），其灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 0.81、0.75、0.90 和 0.60；而斑点征的灵敏度、特异性、PPV 和 NPV 分别为 0.81、0.79、0.73 和 0.86。逻辑回归分析表明，血肿内 IC 与 HE 独立相关（优势比=1.525；95%置信区间，1.041-2.235；p=0.030）。
血肿和斑点征内的 IC 均与 HE 独立相关。光谱成像的 IC 分析有助于识别需要针对性止血治疗的 SICH 患者。
• 斑点征内和血肿内的碘浓度可预测血肿扩大。• 光谱成像可以测量斑点征内的碘浓度和血肿内的碘浓度。• 与 CTA 相比，斑点征内 IC 提高了阳性预测值（PPV）。
