Non-Contrast CT Signs for Acute Intracerebral Hematoma Expansion Prediction: Alternatives to Spot Sign
Piyush Ojha, MBBS, MD, DM
Law ZK, Ali A, Krishnan K, Bischoff A, Appleton JP, Scutt P, et al. Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome, and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage. Stroke. 2020;51:121–128.
Spontaneous intracerebral hemorrhage (ICH) remains a major cause of morbidity and mortality worldwide. Hematoma expansion affects 30-40% of patients with acute ICH within the first few hours of onset; hence, its prevention is an important treatment target in acute ICH care to prevent neurological worsening and poor long-term outcome, thus necessitating more close neurological monitoring. Although the presence of spot sign in Computed Tomography (CT) angiography predicts hematoma expansion, only a minority of ICH patients receives contrast injection during the initial imaging. Since non-contrast CT (NCCT) is widely available and used, NCCT markers represent an important alternative for prediction of hematoma expansion.
NCCT signs can be divided into density markers (swirl sign, blend sign, black hole sign, hypodensity and fluid level) and shape markers (irregular shape, island sign and satellite sign).
Various observational studies, RCT populations and meta-analyses have suggested that NCCT signs markers might be reliable predictors of hematoma expansion and poor outcome in ICH, but with different effect size and strength of association.