Del Carmen González Domínguez María, Fornell-Pérez Roberto, Suárez Ernesto Santana, Sancho Diego Riol, Domínguez Elisabet González, Loro-Ferrer Juan Francisco
Department of Clinical Sciences, University of Las Palmas de Gran Canaria. Las Palmas. Spain. Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas, Spain.
Hospital Universitario Basurto, Bilbao, Spain.
Emerg Radiol. 2025 Jun 12. doi: 10.1007/s10140-025-02352-3.
To evaluate the predictive value of two radiological markers, the spot sign and leakage sign, for spontaneous intracranial hematoma expansion and their association with clinical outcomes, including neurological deterioration and in-hospital mortality.
MATERIALS & METHODS: This prospective single-center study included 94 adult patients with spontaneous intraparenchymal hemorrhagic stroke, confirmed by non-enhanced CT (NECT) and contrast-enhanced CT (CECT) in the arterial phase. Hematoma volumes and spot/leakage signs were assessed using standardized imaging protocols and analyzed by two blinded neuroradiologists. Clinical and radiological data were evaluated using multivariate analyses, with survival outcomes compared via Kaplan-Meier curves. Statistical significance was set at p ≤ 0.05.
Among 94 patients, hematoma expansion occurred in 42%, neurological deterioration in 15.5%, and mortality in 39.4%. The leakage sign was the strongest independent predictor of hematoma expansion (OR: 9.27, 95% CI: 2.95-29.20), neurological deterioration (OR: 26.67, 95% CI: 1.62-47.39), and mortality (OR: 7.56, 95% CI: 2.97-19.25). The spot and leakage signs demonstrated high specificity for predicting outcomes, with the leakage sign showing greater sensitivity for hematoma expansion. Patients with a positive leakage sign had significantly lower median survival (6 days) compared to those with a positive spot sign alone (54 days) or no signs (110 days, p < 0.001).
The leakage sign demonstrated greater sensitivity and comparable specificity to the spot sign for predicting hematoma expansion. Both signs were associated with neurological deterioration and in-hospital mortality, with the leakage sign showing a stronger predictive value.
评估两种影像学标志物——斑点征和渗漏征对自发性颅内血肿扩大的预测价值及其与临床结局（包括神经功能恶化和院内死亡率）的相关性。
这项前瞻性单中心研究纳入了94例成人自发性脑实质出血性卒中患者，均经非增强CT（NECT）和动脉期增强CT（CECT）确诊。使用标准化成像方案评估血肿体积和斑点/渗漏征，并由两名盲法神经放射科医生进行分析。采用多变量分析评估临床和影像学数据，通过Kaplan-Meier曲线比较生存结局。设定统计学显著性为p≤0.05。
94例患者中，42%发生血肿扩大，15.5%出现神经功能恶化，39.4%死亡。渗漏征是血肿扩大（比值比：9.27，95%置信区间：2.95 - 29.20）、神经功能恶化（比值比：26.67，95%置信区间：1.62 - 47.39）和死亡（比值比：7.56，95%置信区间：2.97 - 19.25）的最强独立预测因素。斑点征和渗漏征对预测结局具有较高的特异性，渗漏征对血肿扩大的敏感性更高。渗漏征阳性的患者中位生存期（6天）显著低于仅斑点征阳性的患者（54天）或无征患者（110天，p<0.001）。
在预测血肿扩大方面，渗漏征比斑点征具有更高的敏感性和相当的特异性。两种征象均与神经功能恶化和院内死亡率相关，渗漏征的预测价值更强。
