CT angiographic spot sign (intracerebral haemorrhage)

The CT angiographic (CTA) spot sign is defined as unifocal or multifocal contrast enhancement within an acute primary intracerebral haemorrhage (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 haemorrhage and is an independent predictor of intracerebral haemorrhage 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 recognised much earlier on conventional angiographic studies performed on intracerebral haemorrhage patients in the pre-CT era 3.

Trials of haemostatic therapy (recombinant activated factor VII and tranexamic acid in particular) in intracerebral haemorrhage patients are underway using 'spot sign' based patient selection targeting patients with active bleeding who are most likely to benefit from therapy.

The spot sign should not be confused with the similarly named MCA dot sign, the latter consisting of a hyperdense thrombus within the Sylvian fissure (M2 branches) in acute ischaemic stroke

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Article information

rID: 24482
Section: Signs
Synonyms or Alternate Spellings:
  • CTA spot sign
  • Spot sign
  • CT angiographic (CTA) spot sign
  • CT angiographic spot-sign

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Cases and figures

  • Case 1: CTA spot sign
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