Cerebrovascular and Neurocritical Care Division, Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10 Avenue, Graves Hall, Columbus, OH, 43210, USA.
Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, USA.
J Neurol. 2018 Oct;265(10):2201-2210. doi: 10.1007/s00415-018-8975-8. Epub 2018 Jul 16.
The presence of the spot sign on computed tomography angiogram (CTA) is considered a sign of active bleeding, and studies have shown it can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The spot sign in intraventricular hemorrhage (IVH) has not been explored yet. The purpose of this study is to estimate the prevalence of the intraventricular-spot sign, and its prediction of hematoma expansion and clinical outcomes.
We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2013 to January 2018. A total of 321 subjects were filtered for the prevalence analysis (PA). We further excluded 114 subjects without a follow-up CT-head for the hematoma expansion analysis (HEA). Patients were grouped based on the location of hemorrhage into three groups: isolated IPH with the spot sign always in IPH (i-IPH), isolated IVH with the spot sign always in IVH (i-IVH), and combined IPH and IVH which would be further sub-grouped according to the location of the spot sign: in IPH only (IPH+/IVH) and in IVH only (IPH/IVH+). The prevalence, demographics, and incidence of hematoma expansion were compared between the groups using Pearson's chi-square test and Student's t test.
The prevalence of the spot sign was 8, 20, 17, 5% in (i-IPH), (i-IVH), (IPH+/IVH), and (IPH/IVH+) groups, respectively. The rate of hematoma expansion were (42 vs. 13%), (33 vs. 31%), (80 vs. 22%), and (25 vs. 22%) in spot sign positive vs. negative subjects in each group, respectively (p values = 0.023, = 1, <0.001, and = 1).
We studied the prediction of spot sign on hematoma expansion and clinical outcomes in the different subtypes of ICH. Our study showed that spot sign is a good predictor in IPH but not IVH. Despite the rarity of IVH; the prevalence of spot sign was higher in IVH than IPH. This might be due to anatomical and physiological variations.
计算机断层血管造影（CTA）上的斑点征被认为是活跃性出血的标志，研究表明它可以预测脑实质出血（IPH）中的血肿扩大。脑室出血（IVH）中的斑点征尚未得到探索。本研究旨在评估脑室斑点征的发生率及其对血肿扩大和临床结局的预测价值。
我们从 2013 年 1 月至 2018 年 1 月检索了我们医疗中心的出血性脑卒中患者的数据。对 321 名患者进行了流行率分析（PA）。我们进一步排除了 114 名没有随访头颅 CT 的患者进行血肿扩大分析（HEA）。根据出血部位将患者分为三组：单纯 IPH 伴斑点征始终位于 IPH（i-IPH）、单纯 IVH 伴斑点征始终位于 IVH（i-IVH）以及合并 IPH 和 IVH，进一步根据斑点征的位置分为：仅位于 IPH（IPH+/IVH）和仅位于 IVH（IPH/IVH+）。使用 Pearson's chi-square 检验和 Student's t 检验比较各组之间的流行率、人口统计学和血肿扩大发生率。
斑点征在（i-IPH）、（i-IVH）、（IPH+/IVH）和（IPH/IVH+）组中的发生率分别为 8%、20%、17%和 5%。在每个组中，斑点征阳性与阴性患者的血肿扩大率分别为（42%比 13%）、（33%比 31%）、（80%比 22%）和（25%比 22%）（p 值=0.023，=1，<0.001，=1）。
我们研究了不同类型 ICH 中斑点征对血肿扩大和临床结局的预测价值。我们的研究表明，斑点征在 IPH 中是一个很好的预测指标，但在 IVH 中不是。尽管 IVH 很少见，但 IVH 中的斑点征发生率高于 IPH。这可能是由于解剖和生理上的差异。
