ArticleEmergency radiology2025
Comparative assessment of the spot sign and leakage sign as predictive factors for spontaneous intracranial hematoma expansion.
Article in Emergency radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the predictive value of two radiological markers, the spot sign and leakage sign, for spontaneous intracranial hematoma expansion and their association with clinical outcomes, including neurological deterioration and in-hospital mortality. MATERIALS &
methodsThis prospective single-center study included 94 adult patients with spontaneous intraparenchymal hemorrhagic stroke, confirmed by non-enhanced CT (NECT) and contrast-enhanced CT (CECT) in the arterial phase. Hematoma volumes and spot/leakage signs were assessed using standardized imaging protocols and analyzed by two blinded neuroradiologists. Clinical and radiological data were evaluated using multivariate analyses, with survival outcomes compared via Kaplan-Meier curves. Statistical significance was set at p ≤ 0.05.
resultsAmong 94 patients, hematoma expansion occurred in 42%, neurological deterioration in 15.5%, and mortality in 39.4%. The leakage sign was the strongest independent predictor of hematoma expansion (OR: 9.27, 95% CI: 2.95-29.20), neurological deterioration (OR: 26.67, 95% CI: 1.62-47.39), and mortality (OR: 7.56, 95% CI: 2.97-19.25). The spot and leakage signs demonstrated high specificity for predicting outcomes, with the leakage sign showing greater sensitivity for hematoma expansion. Patients with a positive leakage sign had significantly lower median survival (6 days) compared to those with a positive spot sign alone (54 days) or no signs (110 days, p < 0.001).
conclusionThe leakage sign demonstrated greater sensitivity and comparable specificity to the spot sign for predicting hematoma expansion. Both signs were associated with neurological deterioration and in-hospital mortality, with the leakage sign showing a stronger predictive value.
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