Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Medical Imaging, University of Ottawa, Ottawa, Canada.
PLoS One. 2020 Aug 6;15(8):e0236196. doi: 10.1371/journal.pone.0236196. eCollection 2020.
Dynamic CT angiography (dCTA) contrast extravasation, known as the "dynamic spot sign", can predict hematoma expansion (HE) in intracerebral hemorrhage (ICH). Recent reports suggest the phase of spot sign appearance is related to the magnitude of HE. We used dCTA to explore the association between the phase of spot sign appearance and HE, clinical outcome, and contrast extravasation rates.
We assessed consecutive patients who presented with primary ICH within 4.5 hours from symptom onset who underwent a standardized dCTA protocol and were spot sign positive. The independent variable was the phase of spot sign appearance. The primary outcome was significant HE (either 6 mL or 33% growth). Secondary outcomes included total absolute HE, mortality, and discharge mRS. Mann-Whitney U, Fisher's exact test, and logistic regression were used, as appropriate.
Of the 35 patients with spot signs, 27/35 (77%) appeared in the arterial phase and 8/35 (23%) appeared in the venous phase. Thirty patients had follow-up CT scans. Significant HE was seen in 14/23 (60.87%) and 3/7 (42.86%) of arterial and venous cohorts, respectively (p = 0.67). The sensitivity and specificity in predicting significant HE were 82% and 31% for the arterial phase and 18% and 69% for the venous phase, respectively. There was a non-significant trend towards greater total HE, in-hospital mortality, and discharge mRS of 4-6 in the arterial spot sign cohort. Arterial spot signs demonstrated a higher median contrast extravasation rate (0.137 mL/min) compared to venous spot signs (0.109 mL/min).
Our exploratory analyses suggest that spot sign appearance in the arterial phase may be more likely associated with HE and poorer prognosis in ICH. This may be related to higher extravasation rates of arterial phase spot signs. However, further studies with larger sample sizes are warranted to confirm the findings.
动态 CT 血管造影（dCTA）造影外渗，即“动态斑点征”，可预测脑出血（ICH）的血肿扩大（HE）。最近的报告表明斑点征出现的阶段与 HE 的程度有关。我们使用 dCTA 来探讨斑点征出现的阶段与 HE、临床结局和造影外渗率之间的关系。
我们评估了 35 例发病 4.5 小时内的原发性 ICH 患者，这些患者均接受了标准化的 dCTA 方案且斑点征阳性。独立变量为斑点征出现的阶段。主要结局是显著的 HE（6mL 或 33%的增长）。次要结局包括总绝对 HE、死亡率和出院 mRS。使用了 Mann-Whitney U 检验、Fisher 确切检验和逻辑回归，具体取决于情况。
在 35 例有斑点征的患者中，27/35（77%）出现在动脉期，8/35（23%）出现在静脉期。30 例患者有随访 CT 扫描。动脉组有 14/23（60.87%）出现显著 HE，静脉组有 3/7（42.86%）出现显著 HE（p=0.67）。动脉期预测显著 HE 的敏感性和特异性分别为 82%和 31%，静脉期分别为 18%和 69%。动脉斑点征组的总 HE、住院死亡率和出院 mRS 为 4-6 的趋势更大，但无统计学意义。动脉斑点征的中位造影外渗率（0.137mL/min）高于静脉斑点征（0.109mL/min）。
我们的探索性分析表明，动脉期斑点征的出现可能与 ICH 中的 HE 和预后较差更相关。这可能与动脉期斑点征更高的外渗率有关。然而，需要更大样本量的进一步研究来证实这些发现。
