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Journal of stroke-Dual-energy CT angiography: spot sign can effectively predict hematoma enlargement after intracerebral hemorrhage

 Last Update: 2021-08-04
 Source: Internet
 Author: User

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Intracerebral hemorrhage (ICH) has a high mortality and morbidity rate
.

Most of the factors that predict the outcome of ICH, such as age, Glasgow Coma Scale (GCS) score, initial hematoma volume, and hematoma location, are immutable

In contrast, significant hematoma expansion (HE) occurs in up to one-third of ICH patients, and is a powerful, potentially modifiable, predictive factor for adverse functional outcomes and mortality
.

Spot sign (spot signn, SS) refers to the appearance of one or more enhanced spots in the acute hematoma due to the extravasation of the active contrast agent on the computed tomography angiography (CTA), which has been proven to predict the hematoma and clinical outcome
.

However, different CTA acquisition techniques, such as arterial phase or delayed (venous) phase imaging, have led to a wide range of diagnostic accuracy

Due to the difference in the energy-dependent attenuation curve, DE-CTA can distinguish bleeding and iodinated contrast agents

Between 2014 and 2019, they prospectively included patients with primary ICH who underwent DE-CTA (including the arterial phase and delayed venous phase) and subsequent computed tomography
.

The arterial phase and lag phase images of different DE-CTA data sets were evaluated by SS, that is, traditional hybrid images, iodinated images and fusion images
.

The diagnostic accuracy of SS for predicting HE was determined on all data sets

Among the 139 patients included, 47 showed HE (33.

8%)

They found that the sensitivity of SS to HE was 32% (with an accuracy of 0.
72) on traditional hybrid arterial images, and it was increased to 76% (with an accuracy of 0.
80) on delayed fusion images
.

In traditional hybrid arterial images, the sensitivity of SS to HE is 32% (accuracy rate of 0.
72), which is increased to 76% (accuracy rate of 0.
80) on delayed fusion images
.

In traditional hybrid arterial images, the sensitivity of SS to HE is 32% (accuracy rate of 0.

The appearance of SS on delayed fusion images is independently related to HE (probability [OR], 17.
5; 95% confidence interval [CI], 6.
14 to 49.
82) and adverse consequences (OR, 3.
84; 95% CI, 1.
16 to 12.
73)
.

(When the spot sign is schematic)

The important significance of this research lies in the discovery: the appearance of SS on DE-CTA, especially the appearance of SS on delayed phase fusion images, shows higher diagnostic performance in predicting HE compared with traditional hybrid imaging.
Related to bad outcomes
.

The appearance of SS on DE-CTA, especially the appearance of SS on delayed phase fusion images, shows higher diagnostic performance in predicting HE than traditional hybrid imaging, and is related to poor outcomes
.

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