Sistema de Salut de Catalunya
Institut Català de la Salut
[Pensato U] Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. [Dowlatshahi D] Division of Neurology, Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ontario, Canada. [Rodriguez-Luna D] Unitat d’Ictus, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ospel JM] Department of Radiology, University of Calgary, Cumming School of Medicine, Alberta, Canada. [Morotti A] Department of Clinical and Experimental Sciences, Neurology Unity, University of Brescia, Italy. [Tanaka K] Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada
Vall d'Hebron Barcelona Hospital Campus
2025-07-08T07:28:17Z
2025-07-08T07:28:17Z
2025-06
Angiography; Cerebral hemorrhage; Hemorrhagic stroke
Angiografia; Hemorràgia cerebral; Ictus hemorràgic
Angiografía; Hemorragia cerebral; Ictus hemorrágico
Hematoma expansion (HE) is a common occurrence affecting around 10% to 30% of patients with acute intracerebral hemorrhage within the initial hours from symptom onset and is the only modifiable factor associated with poor clinical outcomes. The detection of contrast extravasation on computed tomography (CT) angiography, known as the spot sign, was initially embraced as a promising radiological marker for predicting HE that could aid patient selection for acute interventions aimed at minimizing HE. However, the initial enthusiasm waned as clinical studies failed to show clear clinical benefits of hemostatic treatments when patients were selected based on the presence of this imaging marker. In this narrative review, we provide a comprehensive summary of the pathophysiology, definitions, imaging protocols, and predictive performance of the spot sign, along with the clinical studies that have selected and treated patients based on its presence. Finally, we delve into some nuances of the spot sign that can enhance its predictive performance and help stratify HE risk with greater precision. These features include static findings observed on single-phase CT angiography (ie, number, volume, CT density, and colocalization with hypodensities), as well as dynamic findings identified on multiphase/dynamic CT angiography (ie, timing of appearance, volume increase, volume decrease for tissue dispersion, and CT density changes). In this reappraisal of the spot sign, we aim to reinvigorate research on advanced neuroimaging in intracerebral hemorrhage that could lead to a more accurate HE prediction. This could facilitate better selection for therapies aimed at preventing HE or surgical approaches to address the bleeding source.
This work was partially supported by Ricerca Corrente funding from Italian Ministry of Health to IRCCS Humanitas Research Hospital.
Article
Published version
English
Hemorràgia cerebral - Imatgeria; Angiografia; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Hematoma; Other subheadings::Other subheadings::Other subheadings::/diagnostic imaging; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Image Interpretation, Computer-Assisted::Tomography, X-Ray Computed::Computed Tomography Angiography; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Intracranial Hemorrhages::Cerebral Hemorrhage; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia::hematoma; Otros calificadores::Otros calificadores::Otros calificadores::/diagnóstico por imagen; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::interpretación de imágenes asistida por ordenador::tomografía computarizada por rayos X::angiografía por tomografía computarizada; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::hemorragia::hemorragias intracraneales::hemorragia cerebral
Wolters Kluwer Health
Stroke;56(6)
https://doi.org/10.1161/STROKEAHA.125.050637
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
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