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http://dx.doi.org/10.3340/jkns.2014.56.4.295

Association Factors for CT Angiography Spot Sign and Hematoma Growth in Korean Patients with Acute Spontaneous Intracerebral Hemorrhage : A Single-Center Cohort Study  

Moon, Byung Hoo (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Jang, Dong-Kyu (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Han, Young-Min (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Jang, Kyung-Sool (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Huh, Ryoong (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Park, Young Sup (Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Publication Information
Journal of Korean Neurosurgical Society / v.56, no.4, 2014 , pp. 295-302 More about this Journal
Abstract
Objective : This study was conducted to clarify the association factors and clinical significance of the CT angiography (CTA) spot sign and hematoma growth in Korean patients with acute intracerebral hemorrhage (ICH). Methods : We retrospectively collected the data of 287 consecutive patients presenting with acute ICH who arrived within 12 hours of ictus. Baseline clinical and radiological characteristics as well as the mortality rate within one month were assessed. A binary logistic regression was conducted to obtain association factors for the CTA spot sign and hematoma growth. Results : We identified a CTA spot sign in 40 patients (13.9%) and hematoma growth in 78 patients (27.2%). An elapsed time to CT scan of less than 3 hours (OR, 5.14; 95% CI, 1.76-15.02; p=0.003) was associated with the spot sign. A CTA spot sign (OR, 5.70; 95% CI, 2.70-12.01; p<0.001), elevated alanine transaminase (GPT) level >40 IU (OR, 2.01; 95% CI, 1.01-4.01; p=0.047), and an international normalized ratio ${\geq}1.8$ or warfarin medication (OR, 5.64; 95% CI, 1.29-24.57; p=0.021) were independent predictors for hematoma growth. Antiplatelet agent medication (OR, 4.92; 95% CI, 1.31-18.50; p= 0.019) was significantly associated with hematoma growth within 6 hours of ictus. Conclusion : As previous other populations, CTA spot sign was a strong predictor for hematoma growth especially in hyper-acute stage of ICH in Korea. Antithrombotics medication might also be associated with hyper-acute hematoma growth. In our population, elevated GPT was newly identified as a predictor for hematoma growth and its effect for hematoma growth is necessary to be confirmed through a further research.
Keywords
Intracerebral hemorrhage; CT angiography; Spot sign; Hematoma growth; Antithrombotics; Alanine transaminase;
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1 Anderson CS, Huang Y, Arima H, Heeley E, Skulina C, Parsons MW, et al. : Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage : the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke 41 : 307-312, 2010   DOI
2 Becker KJ, Baxter AB, Bybee HM, Tirschwell DL, Abouelsaad T, Cohen WA : Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage. Stroke 30 : 2025-2032, 1999   DOI   ScienceOn
3 Brouwers HB, Biffi A, McNamara KA, Ayres AM, Valant V, Schwab K, et al. : Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage. Stroke 43 : 2120-2025, 2012   DOI
4 Brouwers HB, Goldstein JN, Romero JM, Rosand J : Clinical applications of the computed tomography angiography spot sign in acute intracerebral hemorrhage : a review. Stroke 43 : 3427-3432, 2012   DOI
5 Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P; CHANT Investigators : Hematoma growth in oral anticoagulant related intracerebral hemorrhage. Stroke 39 : 2993-2996, 2008   DOI
6 Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, et al. : Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 66 : 1175-1181, 2006   DOI   ScienceOn
7 de Gans K, de Haan RJ, Majoie CB, Koopman MM, Brand A, Dijkgraaf MG, et al. : PATCH : platelet transfusion in cerebral haemorrhage : study protocol for a multicentre, randomised, controlled trial. BMC Neurol 10 : 19, 2010   DOI
8 Delcourt C, Huang Y, Arima H, Chalmers J, Davis SM, Heeley EL, et al. : Hematoma growth and outcomes in intracerebral hemorrhage : the INTERACT1 study. Neurology 79 : 314-319, 2012   DOI
9 Delgado Almandoz JE, Yoo AJ, Stone MJ, Schaefer PW, Oleinik A, Brouwers HB, et al. : The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors. Stroke 41 : 54-60, 2010   DOI
10 Dowlatshahi D, Wasserman JK, Momoli F, Petrcich W, Stotts G, Hogan M, et al. : Evolution of computed tomography angiography spot sign is consistent with a site of active hemorrhage in acute intracerebral hemorrhage. Stroke 45 : 277-280, 2014   DOI
11 Goldstein JN, Fazen LE, Snider R, Schwab K, Greenberg SM, Smith EE, et al. : Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology 68 : 889-894, 2007   DOI   ScienceOn
12 Emlet LL, Crippen D : Early recombinant activated factor VII for intracerebral hemorrhage reduced hematoma growth and mortality, while improving functional outcomes. Crit Care 10 : 304, 2006   DOI
13 Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V : Worldwide stroke incidence and early case fatality reported in 56 population-based studies : a systematic review. Lancet Neurol 8 : 355-369, 2009   DOI   ScienceOn
14 Flibotte JJ, Hagan N, O'Donnell J, Greenberg SM, Rosand J : Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage. Neurology 63 : 1059-1064, 2004   DOI
15 Huttner HB, Schellinger PD, Hartmann M, Kohrmann M, Juettler E, Wik-ner J, et al. : Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy : comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates. Stroke 37 : 1465-1470, 2006   DOI
16 Kim KH : Predictors of 30-day mortality and 90-day functional recovery after primary intracerebral hemorrhage : hospital based multivariate analysis in 585 patients. J Korean Neurosurg Soc 45 : 341-349, 2009   DOI
17 Kim HC, Kang DR, Nam CM, Hur NW, Shim JS, Jee SH, et al. : Elevated serum aminotransferase level as a predictor of intracerebral hemorrhage : Korea medical insurance corporation study. Stroke 36 : 1642-1647, 2005   DOI   ScienceOn
18 Kim HC, Oh SM, Pan WH, Ueshima H, Gu D, Chuang SY, et al. : Association between alanine aminotransferase and intracerebral hemorrhage in East Asian populations. Neuroepidemiology 41 : 131-138, 2013   DOI
19 Li N, Wang Y, Wang W, Ma L, Xue J, Weissenborn K, et al. : Contrast extravasation on computed tomography angiography predicts clinical outcome in primary intracerebral hemorrhage : a prospective study of 139 cases. Stroke 42 : 3441-3446, 2011   DOI
20 Kim J, Smith A, Hemphill JC 3rd, Smith WS, Lu Y, Dillon WP, et al. : Contrast extravasation on CT predicts mortality in primary intracerebral hemorrhage. AJNR Am J Neuroradiol 29 : 520-525, 2008   DOI
21 Marti-Fabregas J, Borrell M, Silva Y, Delgado-Mederos R, Martinez-Ramirez S, de Juan-Delago M, et al. : Hemostatic proteins and their association with hematoma growth in patients with acute intracerebral hemorrhage. Stroke 41 : 2976-2978, 2010   DOI
22 Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, et al. : Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 358 : 2127-2137, 2008   DOI
23 Moussouttas M, Malhotra R, Fernandez L, Maltenfort M, Holowecki M, Delgado J, et al. : Role of antiplatelet agents in hematoma expansion during the acute period of intracerebral hemorrhage. Neurocrit Care 12 : 24- 29, 2010   DOI
24 Naidech AM, Jovanovic B, Liebling S, Garg RK, Bassin SL, Bendok BR, et al. : Reduced platelet activity is associated with early clot growth and worse 3-month outcome after intracerebral hemorrhage. Stroke 40 : 2398- 2401, 2009   DOI
25 Park HS, Kang MJ, Huh JT : Recent epidemiological trends of stroke. J Korean Neurosurg Soc 43 : 16-20, 2008   DOI   ScienceOn
26 Radmanesh F, Falcone GJ, Anderson CD, Battey TW, Ayres AM, Vashkevich A, et al. : Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared. Stroke 45 : 1833-1835, 2014   DOI
27 van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ : Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin : a systematic review and meta-analysis. Lancet Neurol 9 : 167-176, 2010   DOI
28 Rodriguez-Luna D, Pineiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, et al. : Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol 20 : 1277-1283, 2013   DOI
29 Sansing LH, Messe SR, Cucchiara BL, Cohen SN, Lyden PD, Kasner SE, et al. : Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH. Neurology 72 : 1397-1402, 2009   DOI
30 Toyoda K, Okada Y, Minematsu K, Kamouchi M, Fujimoto S, Ibayashi S, et al. : Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage. Neurology 65 : 1000-1004, 2005   DOI
31 Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II) : a randomised trial. Lancet 382 : 397-408, 2013   DOI
32 Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, et al. : CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 38 : 1257-1262, 2007   DOI   ScienceOn
33 Wang YH, Fan JY, Luo GD, Lin T, Xie DX, Ji FY, et al. : Hematoma volume affects the accuracy of computed tomographic angiography 'spot sign' in predicting hematoma expansion after acute intracerebral hemorrhage. Eur Neurol 65 : 150-155, 2011   DOI
34 Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L, et al. : Racial variations in location and risk of intracerebral hemorrhage. Stroke 36 : 934-937, 2005   DOI
35 Park SY, Kong MH, Kim JH, Kang DS, Song KY, Huh SK : Role of 'spot sign' on CT angiography to predict hematoma expansion in spontaneous intracerebral hemorrhage. J Korean Neurosurg Soc 48 : 399-405, 2010   DOI   ScienceOn
36 Takeda R, Ogura T, Ooigawa H, Fushihara G, Yoshikawa S, Okada D, et al. : A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage. Clin Neurol Neurosurg 115 : 1028-1031, 2013   DOI
37 Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, Molina CA, Blas YS, Dzialowski I, et al. : Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT) : a prospective observational study. Lancet Neurol 11 : 307-314, 2012   DOI
38 Delgado Almandoz JE, Yoo AJ, Stone MJ, Schaefer PW, Goldstein JN, Rosand J, et al. : Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion : the spot sign score. Stroke 40 : 2994-3000, 2009   DOI
39 Ederies A, Demchuk A, Chia T, Gladstone DJ, Dowlatshahi D, Bendavit G, et al. : Postcontrast CT extravasation is associated with hematoma expansion in CTA spot negative patients. Stroke 40 : 1672-1676, 2009   DOI
40 Hallevi H, Abraham AT, Barreto AD, Grotta JC, Savitz SI : The spot sign in intracerebral hemorrhage : the importance of looking for contrast extravasation. Cerebrovasc Dis 29 : 217-220, 2010   DOI