BACKGROUND AND PURPOSE: The presence of spot sign is associated with a high risk of hematoma growth. Our aim was to investigate the timing of the appearance, volume, and leakage rate of the spot sign for predicting hematoma growth in acute intracerebral hemorrhage using multiphase CTA. MATERIALS AND METHODS: In this single-center retrospective study, multiphase CTA in 3 phases was performed in acute intracerebral hemorrhage (defined as intraparenchymal ± intraventricular hemorrhages). Phases of the spot sign first appearance, spot sign volumes (microliter), and leakage rates among phases (microliter/second) were measured. Associations between baseline clinical and imaging variables including spot sign volume parameters (volume and leakage rate divided by median) and hematoma growth (>6 mL) were investigated using regression models. Receiver operating characteristic analysis was used as appropriate. RESULTS: Two hundred seventeen patients (131 men; median age, 70 years) were included. The spot sign was detected in 21.7%, 30.0%, and 29.0% in the first, second, and third phases, respectively, with median volumes of 19.7, 31.4, and 34.8 μl in these phases. Hematoma growth was seen in 44 patients (20.3%). By means of modeling, the following variables, namely the spot sign appearing in the first phase, first phase spot sign volume, spot sign appearing in the second or third phase, and spot sign positive and negative leakage rates, were associated with hematoma growth. Among patients with a spot sign, the absolute leakage rate accounting for both positive and negative leakage rates was also associated with hematoma growth (per 1-μl/s increase; OR, 1.26; 95% CI, 1.04-1.52). Other hematoma growth predictors were stroke history, baseline NIHSS score, onset-to-imaging time, and baseline hematoma volume (all P values < .05). CONCLUSIONS: The timing of the appearance of the spot sign, volume, and leakage rate were all associated with hematoma growth. Development of automated software to generate these spot sign volumetric parameters would be an important next step to maximize the potential of temporal intracerebral hemorrhage imaging such as multiphase CTA for identifying those most at risk of hematoma growth.

Department of Biomedical Engineering Huazhong University of Science and Technology Wuhan China

Department of Community Health Sciences University of Calgary Calgary Alberta Canada

Department of Medicine Division of Neurology University of Alberta Edmonton Alberta Canada

Department of Medicine Division of Neurology University of British Columbia Vancouver British Columbia Canada

Department of Medicine Division of Neurology University of Ottawa Ottawa Ontario Canada

Department of Medicine Division of Neurology University of Saskatchewan Saskatoon Canada

Department of Neurology Kyoto Prefectural University of Medicine Kyoto Japan

Department of Neurology National Institute of Mental Health and Neurosciences Bengaluru India

Department of Neurology University Ostrava Ostrava Czech Republic

Department of Neurology Vall d'Hebron University Hospital Barcelona Spain

Department of Radiology University of Calgary Calgary Alberta Canada

From the Foothills Medical Centre Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada

Hotchikiss Brain Institute Cumming School of Medicine University of Calgary Calgary Canada

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Co-localization of NCCT hypodensity and CTA spot sign predicts substantial intracerebral hematoma expansion: The Black-&-White sign