BACKGROUND AND PURPOSE: The spot sign score (SSS) provides risk stratification for hematoma expansion in acute intracerebral hemorrhage; however, external validation is needed. We sought to validate the SSS and assess prognostic performance of individual spot characteristics associated with hematoma expansion from a prospective multicenter intracerebral hemorrhage study. METHODS: Two hundred twenty-eight intracerebral hemorrhage patients within 6 hours after ictus were enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study, a multicenter prospective intracerebral hemorrhage cohort study. Patients were evaluated with baseline noncontrast computerized tomography, computerized tomography angiography, and 24-hour follow-up computerized tomography. Primary outcome was significant hematoma expansion (>6 mL or >33%) and secondary outcome was absolute and relative expansion. Blinded computerized tomography angiography spot sign characterization and SSS calculation were independently performed by 2 neuroradiologists and a radiology resident. Diagnostic performance of the SSS and individual spot characteristics were examined with multivariable regression, receiver operating characteristic analysis, and tests for trend. RESULTS: SSS and spot number independently predicted significant, absolute, and relative hematoma expansion (P<0.05 each) and demonstrated near perfect interobserver agreement (κ=0.82 and κ=0.85, respectively). Incremental risk of hematoma expansion among spot-positive patients was not identified for SSS (P trend=0.720) but was demonstrated for spot number (P trend=0.050). Spot number and SSS demonstrated similar area under the curve (0.69 versus 0.68; P=0.306) for hematoma expansion. CONCLUSIONS: Multicenter external validation of the SSS demonstrates that the spot number alone provides similar prediction but improved risk stratification of hematoma expansion compared with the SSS.
BACKGROUND AND PURPOSE: The spot sign score (SSS) provides risk stratification for hematoma expansion in acute intracerebral hemorrhage; however, external validation is needed. We sought to validate the SSS and assess prognostic performance of individual spot characteristics associated with hematoma expansion from a prospective multicenter intracerebral hemorrhage study. METHODS: Two hundred twenty-eight intracerebral hemorrhagepatients within 6 hours after ictus were enrolled in the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study, a multicenter prospective intracerebral hemorrhage cohort study. Patients were evaluated with baseline noncontrast computerized tomography, computerized tomography angiography, and 24-hour follow-up computerized tomography. Primary outcome was significant hematoma expansion (>6 mL or >33%) and secondary outcome was absolute and relative expansion. Blinded computerized tomography angiography spot sign characterization and SSS calculation were independently performed by 2 neuroradiologists and a radiology resident. Diagnostic performance of the SSS and individual spot characteristics were examined with multivariable regression, receiver operating characteristic analysis, and tests for trend. RESULTS:SSS and spot number independently predicted significant, absolute, and relative hematoma expansion (P<0.05 each) and demonstrated near perfect interobserver agreement (κ=0.82 and κ=0.85, respectively). Incremental risk of hematoma expansion among spot-positive patients was not identified for SSS (P trend=0.720) but was demonstrated for spot number (P trend=0.050). Spot number and SSS demonstrated similar area under the curve (0.69 versus 0.68; P=0.306) for hematoma expansion. CONCLUSIONS: Multicenter external validation of the SSS demonstrates that the spot number alone provides similar prediction but improved risk stratification of hematoma expansion compared with the SSS.
Authors: Andrea Morotti; Javier M Romero; Michael J Jessel; Andrew M Hernandez; Anastasia Vashkevich; Kristin Schwab; Joseph D Burns; Qaisar A Shah; Thomas A Bergman; M Fareed K Suri; Mustapha Ezzeddine; Jawad F Kirmani; Sachin Agarwal; Angela Hays Shapshak; Steven R Messe; Chitra Venkatasubramanian; Katherine Palmieri; Christopher Lewandowski; Tiffany R Chang; Ira Chang; David Z Rose; Wade Smith; Chung Y Hsu; Chun-Lin Liu; Li-Ming Lien; Chen-Yu Hsiao; Toru Iwama; Mohammad Rauf Afzal; Christy Cassarly; Steven M Greenberg; Renee' Hebert Martin; Adnan I Qureshi; Jonathan Rosand; John M Boone; Joshua N Goldstein Journal: Neuroradiology Date: 2017-07-20 Impact factor: 2.804
Authors: Andrea Morotti; Michael J Jessel; H Bart Brouwers; Guido J Falcone; Kristin Schwab; Alison M Ayres; Anastasia Vashkevich; Christopher D Anderson; Anand Viswanathan; Steven M Greenberg; M Edip Gurol; Javier M Romero; Jonathan Rosand; Joshua N Goldstein Journal: Neurocrit Care Date: 2016-08 Impact factor: 3.210
Authors: A Morotti; J M Romero; M J Jessel; H B Brouwers; R Gupta; K Schwab; A Vashkevich; A Ayres; C D Anderson; M E Gurol; A Viswanathan; S M Greenberg; J Rosand; J N Goldstein Journal: AJNR Am J Neuroradiol Date: 2016-05-19 Impact factor: 3.825
Authors: Omar Hussein; Khalid Sawalha; Mohammad Hamed; Ahmed Abd ElAzim; Lai Wei; Michel T Torbey; Archana Hinduja Journal: J Neurol Date: 2018-07-16 Impact factor: 4.849