Abstract Details

Title Spot Sign Characteristics and Hematoma Expansion in Acute Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-008

Objective We investigated how features other than presence of computed tomography angiography (CTA) spot sign, such as spot sign location, number, intensity, and size, influence hematoma expansion in acute intracerebral hemorrhage (ICH).

Background In 1971, C. Miller Fisher described the concept of a spot sign, now considered a biomarker of ongoing bleeding and predictor of acute ICH expansion. However, a considerable number of patients with a spot sign do not experience expansion, which points to the possibility that other factors are involved in hemorrhagic growth. In the spirit of C.M. Fisher’s observations 50 years ago, we hypothesized that factors such as spot sign location, volume, and intensity may correlate with expansion.

Design/Methods We retrospectively reviewed clinical and radiological features in consecutive ICH patients admitted over a three-year period to a comprehensive stroke center. Hematoma expansion was defined conventionally as a >33% increase in hematoma volume or >6ml increase in absolute hematoma volume between baseline and 24-hour follow-up brain CT. CTA images were examined for the presence of a spot sign. We studied the relationship between expansion and spot sign characteristics, including number, volume, and location (central versus peripheral).

Results CTA was obtained in 308 of 417 patients (73%). Hematoma expansion occurred in 72/308 (23%) cases, associated with increased age and spot sign presence. A spot sign was found in 39/308 (13%). Only spot sign volume was linked to expansion in univariate analysis (p = 0.04) and receiver operator analysis (area under the curve [AUC] = 0.68, p = 0.05). In multivariable modeling including age, spot sign location, volume, number, and Hounsfield unit, no independent predictors of expansion were found.

Conclusions We confirmed the influence of spot sign presence on hematoma expansion. Hematoma volume may be a more important predictor of growth than other spot sign features. We encourage further studies to potentially corroborate these findings.

Authors/Disclosures
Tiffany A. Eatz, MD (University of Miami Miller School of Medicine) PRESENTER	Dr. Eatz has nothing to disclose.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
Berje H. Shammassian, MD (LSUHSC - New Orleans/University Medical Center)	Dr. Shammassian has nothing to disclose.
Whitney E. Mayberry, MD (Jackson Memorial Hospital)	Dr. Mayberry has nothing to disclose.
Alexis Alvarado Arias, MD (University of Mississippi)	Dr. Alvarado Arias has nothing to disclose.
Amedeo Merenda, MD (Univeristy of Miami Miller School of Medicine)	Dr. Merenda has nothing to disclose.
Ayham M. Alkhachroum, MD (Columbia University Medical Center)	The institution of Dr. Alkhachroum has received research support from Miami CTSI.

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