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Karger_ESC London_2013

22. European Stroke Conference 5 Intracerebral/subarachnoid haemorrhage and venous diseases 11:10 - 11:20 Venous CTA acquisition phase increase spot sign detection in acute ICH, but spot signs detected in arterial phase have more frequent and larger hematoma expansion. D. Rodriguez-Luna1, D. Dowlatshahi2, R.I. Aviv3, C.A. Molina4, Y. Silva Blas5, I. Dzialows-ki6, C. Lum7, A. Czlonkowska8, J.M. Boulanger9, C.S. Kase10, G. Gubitz11, R. Bhatia12, T. Stew-art13, M.D. Hill14, A.M. Demchuk15 for the PREDICT/Sunnybrook ICH CTA study group Vall d’Hebron University Hospital, Barcelona, SPAIN1,University of Ottawa, Ottawa, CAN-ADA2, University of Toronto, Toronto, CANADA3, Vall d’Hebron University Hospital, Bar-celona, SPAIN4, Dr Josep Trueta University Hospital, Girona, SPAIN5, University of Dresden, Dresden, GERMANY6, University of Ottawa, Ottawa, CANADA7, Institute of Psychiatry and Neurology of Warsaw, Warsaw, POLAND8, University of Sherbrooke, Montreal, CANADA9, Boston Medical Center, Boston, USA10, Dalhousie University, Halifax, CANADA11, All India Institute of Medical Sciences, New Delhi, INDIA12, University of Calgary, Calgary, CANA-DA13, University of Calgary, Calgary, CANADA14, University of Calgary, Calgary, CANADA15 Background: Variability in computed tomography angiography (CTA) acquisitions may be one explanation for the modest accuracy of the spot sign for predicting hematoma expansion de-tected in the multicenter PREDICT study (sensitivity 51%, and positive predictive value 61%). Therefore, the present analysis aimed to determine the frequency of the CTA spot sign depend-ing on the phase of image acquisition, and whether an early phase spot sign has greater hemato-ma expansion compared to later phases. Methods: PREDICT was a multicentric, prospective, observational cohort study of intracere-bral hemorrhage (ICH) patients presenting within 6 hours from symptom onset. The Hounsfield units of an arterial and venous structure were measured on CTA source images of the entire PREDICT cohort. Each CTA study was classified in arterial or venous phase, and in one of five image acquisition phases (early arterial, peak arterial, equilibrium, peak venous, and late ve-nous). Significant hematoma expansion (>33% or >6 mL) and total hematoma (intracerebral and intraventricular hemorrhage) enlargement from baseline were recorded at 24 hours. Results: Overall (n=371), 77.9% of CTA were acquired in arterial phase. The spot sign, present in 29.9% of patients, was more frequent in venous phase as compared with arterial phase (39% vs. 27.3%, p=0.041) and as later the phase of image acquisition was (p=0.093; Figure). Signifi-cant hematoma expansion occurred in 27.8% of patients. More frequently significant hematoma expansion (p=0.176) and higher total hematoma enlargement (p=0.019) was observed in spot sign-positive patients with earlier phases of image acquisition (Figure). Conclusions: Later image acquisition of CTA improves the frequency of spot sign detection. However, spot signs identified in earlier phases may be associated with more frequent hemato-ma expansion and greater absolute enlargement. A multiphase CTA including arterial and ve-nous acquisition would be optimal in ICH patients. 130 © 2013 S. Karger AG, Basel Scientific Programme


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