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“Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the association between dynamic progressive enhancing foci (“dynamic spot sign”) in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion.

Methods

One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed.

Results

Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386–590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123–1295.488), P < 0.0001.

Conclusions

The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign.

Key Points

• It is important to identify potential progression of spontaneous intracerebral haemorrhage.

• Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion.

• The CTP dynamic spot sign may be present throughout arterial to venous phase imaging.

• The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.

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Abbreviations

AHA:

American Heart Association

APTT:

Activated partial thromboplastin time

CTA-SI:

Computed tomography angiography source images

CTP-SI:

Computed tomography perfusion source images

ICH:

Intracerebral haemorrhage

INR:

International normalised ratio

SBP:

Systolic blood pressure

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Acknowledgments

This work was supported by the National Key Project of Scientific and Technical Supporting Programmes funded by the Ministry of Science & Technology of China during the 11th 5-year plan (no. 2007BAI05B07).

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Authors and Affiliations

  1. Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Sheng-Jun Sun, Pei-Yi Gao, Bin-Bin Sui, Xin-Yi Hou, Yan Lin & Jing Xue

  2. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Ren-You Zhai

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  1. Sheng-Jun Sun
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  2. Pei-Yi Gao
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Correspondence to Pei-Yi Gao.

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Sun, SJ., Gao, PY., Sui, BB. et al. “Dynamic spot sign” on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage. Eur Radiol 23, 1846–1854 (2013). https://doi.org/10.1007/s00330-013-2803-4

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  • DOI: https://doi.org/10.1007/s00330-013-2803-4

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