Postcontrast CT Extravasation Is Associated With Hematoma Expansion in CTA Spot Negative Patients

• Published in: Stroke (1970) Vol. 40; no. 5; pp. 1672 - 1676
• Main Authors: EDERIES, Ashraf, DEMCHUK, Andrew, CHIA, Tze, GLADSTONE, David J, DOWLATSHAHI, Dar, BENDAVIT, Gabriel, WONG, Kelly, SYMONS, Sean P, AVIV, Richard I
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2009
• Subjects: Adult; Aged; Biological and medical sciences; Blood Pressure - physiology; Cerebral Angiography; Cerebral Hemorrhage - pathology; Extravasation of Diagnostic and Therapeutic Materials - complications; Female; Humans; Image Processing, Computer-Assisted; Male; Medical sciences; Middle Aged; Neurology; Orthopedic surgery; Partial Thromboplastin Time; Retrospective Studies; Stroke - diagnostic imaging; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed - adverse effects; Vascular diseases and vascular malformations of the nervous system; Human; Stroke; Nervous system diseases; Angiography; spot sign mimic; Cardiovascular disease; computed tomography angiography; contrast extravasation; Cerebral disorder; Vascular disease; Extravasation; Central nervous system disease; Hematoma; Computerized axial tomography; Cerebrovascular disease; CTA spot sign; hematoma expansion
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.108.541201

The purpose of this study was to assess the effect of postcontrast CT (PCCT) leakage (PCL) on hematoma growth in CTA spot negative patients. A retrospective study of 61 patients presenting within 6 hours of primary ICH onset imaged with CT angiography (CTA) and PCCT. Presence of CTA spot sign and PCL were documented. PCL was defined as the presence of contrast extravasation on the PCCT study at a location remote from the CTA spot sign if present. Hematoma expansion was defined as >6 mL or 30% hematoma enlargement. Patients were dichotomized by CTA spot sign presence and PCL and compared for baseline demographic data, hematoma size, and growth using the unpaired t test and Mann-Whitney test for continuous and categorical data, respectively. A probability value <0.05 was considered significant. PCL was present in 11/61 patients (18%), occurring in 5 without a spot sign (45%). Spot negative PCL patients demonstrated larger absolute (P=0.02) and percentage hematoma growth (P=0.02) compared to those without PCL. The mean volume and percent increase was 6.7 mL and 26%, respectively. Inclusion of PCL together with CTA spot sign as risk factor for hematoma expansion increased sensitivity from 0.78 (95% CI; 0.52 to 0.94) to 0.94 (95% CI; 0.72 to 1.00) and NPV from 0.90 (95% CI; 0.76 to 0.97) to 0.97 (95% CI; 0.85 to 1.00). Inclusion of PCCT in the investigation of ICH patients allows detection of PCL which, together with the CTA spot sign, increases sensitivity and negative predictive value for predicting hematoma expansion. This finding should be validated in larger studies.