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Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Stroke 2016 ; 47 (3): 695-700 Nephropedia Template TP
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Predicting intracerebral hemorrhage growth with the spot sign: the effect of onset to scan time #MMPMID26846857
Dowlatshahi D; Brouwers HB; Demchuk AM; Hill MD; Aviv RI; Ufholz LA; Reaume M; Wintermark M; Hemphill JC; Murai Y; Wang Y; Zhao X; Wang Y; Li N; Sorimachi T; Matsumae M; Steiner T; Rizos T; Greenberg SM; Romero JM; Rosand J; Goldstein JN; Sharma M
Stroke 2016[Mar]; 47 (3): 695-700 PMID26846857show ga
Background and Purpose: Hematoma expansion following acute intracerebral hemorrhage (ICH) is common and is associated with early deterioration and poor clinical outcome. The CT angiography (CTA) spot sign is a promising predictor of expansion, however frequency and predictive values are variable across studies, possibly due to differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign. Methods: We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to five pre-defined categorized onset-to-CTA times. We calculated spot sign frequency both as raw and frequency-adjusted rates. Results: Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot sign status and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up CTs for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within two hours of onset to 13% beyond eight hours (p<0.001). There was a significant decrease in hematoma expansion in spot positive patients as onset-to-CTA time increased (p=0.004), with positive predictive values decreasing from 53% to 33%. Conclusions: The frequency of the CTA spot sign is inversely related to ICH onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk-stratification for patients with acute ICH, and will help refine clinical prediction rules for ICH expansion.