Abstract W P253: Swirl Sign is a Robust Predictor of Spot Sign and Poor Outcome in Ultra-early ICH Patients
Background: Spot sign on computed tomography angiography (CTA) is a marker of on-going bleeding and poor outcome in ICH patients. CTA is not as widely available as non-contrast CT (NCCT). The swirl sign is a less well described marker of on-going bleeding on NCCT. We investigated, if the swirl sign can predict spot sign on CTA and as well as its ability to predict poor outcome in ultra-early ICH patients.
Method: We included 137 patients with spontaneous ICH admitted within 4.5 hours from symptom onset from April 2009 to January 2013. Standard work up included NCCT and CTA. The swirl sign on NCCT was defined as regions of hypo- or isodensity located within the hyperdens haematoma with brain parenchyma as reference. Modified Rankin Scale (mRS) was assessed at 3 months (out-patient clinic or by telephone).
Results: Of the 35 (25.5%) patients with a swirl sign on NCCT, 27 (77%) also had spot sign on CTA. This yields a high specificity and negative predictive value (0.92 and 0.86 respectably) and a slightly lower sensitivity and positive predictive value (0.66 and 0.77 respectably). The swirl sign emerged as a highly significant predictor of the spot sign (OR 15.5 CI: 5.6-42.8), adjusted for admission haematoma volume and time to scan.
Swirl sign was associated with poorer median [IQR] outcome after 3 months (5 [4-6] vs. 3 [2-5], p < 0.0001). Swirl sign was an independent predictor of poor outcome (mRS 5-6) (OR 3.28 CI: 1.15-9.34) adjusted for age, admission NIHSS, and admission haematoma volume. The presence of both spot and swirl sign did not add to the prediction of poor outcome.
Conclusion: Swirl sign is a valid marker for the presence of spot sign. The swirl sign entails poor outcome irrespective of other independent predictors. Further studies are needed to evaluate the value of the swirl sign in clinical decision-making and trials.
Author Disclosures: C. Ovesen: None. I. Havsteen: None. A. Christensen: None. C. Krarup: None. H. Christensen: None.
- © 2014 by American Heart Association, Inc.