Multi-detector CT-angiography is useful in predicting haematoma expansion in patients with acute primary intracerebral hemorrhage

Abstract

Background: Primary ICH expands in up to 50% of cases and in these treatment with haemostatic compounds can be potentially beneficial. Spot sign detection on multi-detector CT-angiography (MDCTA) studies may identify ongoing bleeding and thus predict haematoma expansion. Aim: To assess the frequency, the prognostic impact and subsequent haematoma volume increase in patients with positive spot sign in comparison to no spot sign. Method: A non-contrast CT scan (NCCT) and MDCTA was performed routinely in patients with ICH within 3 hours. A NCCT was performed next day. Two radiologists reviewed MDCTAs for spot sign and estimated the haematoma volume in the acute and follow-up NCCTs with the ABC/2 method of measurement. The study was approved by the Danish Data Protection Agency file no 2009-41-313. Results: In 41.4% of patients spot sign was observed. There was a strong trend that positive spot sign predicted short term mortality 35,9 (CI 0,857;1503,2) (p=0,041) adjusted for age and acute haematoma volume. Mean acute volume was 49,0 ml in patients with spot sign vs. 19,2 ml, (p=0,001). The mean volume increase in patients with spot sign was 12,0 ml corresponding to a 24,5% increase in patients with spot sign in comparison to 10,4% in other patients (p= 0,009). Conclusion: Spot sign identifies patients with later haematoma expansion, and may be useful in identifying patients for proof of principle trials in acute ICH, e.g. testing haemostatic compounds or blood pressure reduction.