The CT angiographic (CTA) spot sign is defined as unifocal or multifocal contrast enhancement within an acute primary intracerebral hemorrhage (ICH) visible on CTA source images and discontinuous from adjacent normal or abnormal blood vessels 1. It should not be present on pre-contrast images. It corresponds to a site of active, dynamic hemorrhage and is an independent predictor of ICH growth and poor outcome 2. Of those patients scanned within 6 hours of symptom onset, about 30% will demonstrate the spot sign 2.
The sign was first formally described by Wada et al. in 2007 1, but the phenomenon was recognized much earlier on conventional angiographic studies performed on ICH patients in the pre-CT era 3.
Trials of hemostatic therapy (recombinant activated factor VII and tranexamic acid in particular) in ICH patients are underway using 'spot sign' based patient selection targeting patients with active bleeding who are most likely to benefit from therapy.
- 1. Wada R, Aviv RI, Fox AJ et-al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38 (4): 1257-62. doi:10.1161/01.STR.0000259633.59404.f3 - Pubmed citation
- 2. Demchuk AM, Dowlatshahi D, Rodriguez-Luna D et-al. Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT): a prospective observational study. Lancet Neurol. 2012;11 (4): 307-14. doi:10.1016/S1474-4422(12)70038-8 - Pubmed citation
- 3. Mizukami M, Araki G, Mihara H et-al. Arteriographically visualized extravasation in hypertensive intracerebral hemorrhage. Report of seven cases. Stroke. 1973;3 (5): 527-37. Pubmed citation