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(Stroke. 2009;40:1672.)
© 2009 American Heart Association, Inc.

Original Contributions

Postcontrast CT Extravasation Is Associated With Hematoma Expansion in CTA Spot Negative Patients

Ashraf Ederies, MBChB; Andrew Demchuk, MD, FRCPC; Tze Chia, BSc; David J. Gladstone, MD, PhD, FRCPC; Dar Dowlatshahi, MD, PhD; Gabriel BenDavit, MD; Kelly Wong; Sean P. Symons, MD Richard I. Aviv, MBChB

From the Division of Neuroradiology and Department of Medical Imaging (A.E., G.B., K.W., S.P.S., R.I.A.), the Department of Neurology and North and East GTA Regional Stroke Centre (D.J.G.), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Seaman Family MR Research Centre and Departments of Clinical Neurosciences (D.D., A.M.D.), Foothills Medical Centre, Calgary Health Region, Canada.

Correspondence to Dr R. Aviv, Diagnostic Imaging, Division of Neuroradiology, Room AG 31, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. E-mail richard.aviv{at}sunnybrook.ca

Background and Purpose— The purpose of this study was to assess the effect of postcontrast CT (PCCT) leakage (PCL) on hematoma growth in CTA spot negative patients.

Methods— A retrospective study of 61 patients presenting within 6 hours of primary ICH onset imaged with CT angiography (CTA) and PCCT. Presence of CTA spot sign and PCL were documented. PCL was defined as the presence of contrast extravasation on the PCCT study at a location remote from the CTA spot sign if present. Hematoma expansion was defined as >6 mL or 30% hematoma enlargement. Patients were dichotomized by CTA spot sign presence and PCL and compared for baseline demographic data, hematoma size, and growth using the unpaired t test and Mann-Whitney test for continuous and categorical data, respectively. A probability value <0.05 was considered significant.

Results— PCL was present in 11/61 patients (18%), occurring in 5 without a spot sign (45%). Spot negative PCL patients demonstrated larger absolute (P=0.02) and percentage hematoma growth (P=0.02) compared to those without PCL. The mean volume and percent increase was 6.7 mL and 26%, respectively. Inclusion of PCL together with CTA spot sign as risk factor for hematoma expansion increased sensitivity from 0.78 (95% CI; 0.52 to 0.94) to 0.94 (95% CI; 0.72 to 1.00) and NPV from 0.90 (95% CI; 0.76 to 0.97) to 0.97 (95% CI; 0.85 to 1.00).

Conclusion— Inclusion of PCCT in the investigation of ICH patients allows detection of PCL which, together with the CTA spot sign, increases sensitivity and negative predictive value for predicting hematoma expansion. This finding should be validated in larger studies.

Key Words: computed tomography angiography • contrast extravasation • CTA spot sign • spot sign mimic • hematoma expansion