ArticleCureus2025
Contrast Extravasation on Computed Tomography Angiography as a Predictor of Hematoma Expansion and Outcomes in Spontaneous Intracerebral Hemorrhage: A Retrospective Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed, 1 synthesis or guideline pooled it.
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4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundContrast extravasation ("spot sign") on computed tomography angiography (CTA) is a key imaging biomarker of active bleeding in spontaneous intracerebral hemorrhage (ICH) and is strongly associated with hematoma expansion and poor outcomes. However, data from Middle Eastern populations remains limited. This study aimed to identify the clinical and radiologic predictors of contrast extravasation and to assess its association with hematoma expansion and functional outcomes among patients with spontaneous ICH. MATERIALS AND
methodsWe conducted a multicenter retrospective cohort study of adult patients with spontaneous ICH who underwent non-contrast head CT and CTA at presentation between January 2020 and December 2024. Baseline demographic, clinical, and imaging data were collected. Contrast extravasation was defined as a focus of hyperattenuation ≥120 HU within the hematoma on CTA, discontinuous from normal vessels. The primary outcome was the presence of contrast extravasation. Secondary outcomes included hematoma expansion on follow-up CT and poor functional outcome at 90 days. Independent predictors were identified using multivariable logistic regression.
resultsA total of 450 patients (mean age 66.1 ± 12.0 years; 58.0% men) were included. Contrast extravasation was observed in 141 patients (31.3%). Independent predictors of contrast extravasation were larger baseline hematoma volume (adjusted odds ratio (aOR) 1.32 per 10-mL increase; 95% CI, 1.18-1.47; P < 0.001), higher systolic blood pressure (SBP) (aOR 1.19 per 10-mm Hg increase; 95% CI, 1.05-1.35; P = 0.006), and anticoagulant use (aOR 2.42; 95% CI, 1.50-3.90; P < 0.001). Contrast extravasation was strongly associated with hematoma expansion (aOR 2.94; 95% CI, 1.82-4.75; P < 0.001) and poor 90-day functional outcome (aOR 1.68; 95% CI, 1.06-2.66; P = 0.028). In-hospital mortality was higher among spot-positive patients (18.0% vs. 6.0%).
conclusionsContrast extravasation on CTA was present in nearly one-third of patients with spontaneous ICH in this Saudi multicenter cohort and independently predicted hematoma expansion and unfavorable outcomes. Larger hematoma volume, elevated SBP, and anticoagulant therapy were the strongest predictors. Routine assessment for the spot sign during acute ICH imaging may enhance early risk stratification and guide targeted management strategies.
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