Document Detail

Vascular and nonvascular mimics of the CT angiography "spot sign" in patients with secondary intracerebral hemorrhage.
MedLine Citation:
PMID:  18292380     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The newly-described computed tomography angiography (CTA) Spot Sign is present in about one third of patients with acute primary intracerebral hemorrhage (PICH) and predicts hematoma expansion. This sign has not been systematically evaluated in patients with secondary causes of ICH, and mimics have not been characterized. The purpose of this study was to assess for the presence of the Spot Sign in secondary ICH and to document potential mimics of the Spot Sign and their distinguishing features. METHODS: We performed a retrospective chart review of consecutive patients presenting with ICH to our regional stroke center between January 2002 and May 2007. Ninety-six ICH patients underwent a CT stroke protocol including CTA. CTA documented a secondary cause for hemorrhage in 30 patients (31%). Each patient was assessed for the presence or absence of the CTA Spot Sign or a mimic by 2 blinded neuroradiologists. Clinical and radiological features of PICH and secondary ICH were compared. RESULTS: No patients with secondary ICH had a true CTA Spot Sign, but several Spot Sign mimics were identified including: micro AVM, posterior communicating artery aneurysm, Moya Moya, and neoplasm-associated calcification. The secondary ICH group was younger (P=0.0001) and less likely to be hypertensive at presentation (P=0.0114). Significant hematoma expansion (>33% increase from baseline volume) occurred in 20% of secondary ICH patients and 28% of PICH patients (P=0.2463). CONCLUSIONS: This study describes mimics of the CTA Spot Sign and classifies them as vascular (microAVM, aneurysm, Moya Moya) or nonvascular (tumor and choroid plexus calcification). Evaluation of the noncontrast CT together with the CTA source images is an essential part of the evaluation for the Spot Sign. Vessels entering the hematoma from the periphery are indicative of an underlying vascular lesion. Our findings suggest that the Spot Sign may be rare in secondary ICH and most specific for PICH.
Steve Gazzola; Richard I Aviv; David J Gladstone; Gabriella Mallia; Vivian Li; Allan J Fox; Sean P Symons
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-21
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  39     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-25     Completed Date:  2008-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1177-83     Citation Subset:  IM    
Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
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MeSH Terms
Aged, 80 and over
Arteriovenous Fistula / complications,  radiography
Brain Neoplasms / complications,  radiography
Cerebral Angiography*
Cerebral Hemorrhage / etiology*,  radiography*
Diagnosis, Differential
Hematoma / etiology,  radiography
Intracranial Arteriovenous Malformations / complications,  radiography
Middle Aged
Moyamoya Disease / complications,  radiography
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed*

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