CT angiographic spot sign (intracerebral hemorrhage)

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.

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 ischemic 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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  • Case 2
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