Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

David Rodriguez-Luna; Teri Stewart; Dar Dowlatshahi; Jayme C Kosior; Richard I Aviv; Carlos A Molina; Yolanda Silva; Imanuel Dzialowski; Cheemun Lum; Anna Czlonkowska; Jean-Martin Boulanger; Carlos S Kase; Gord Gubitz; Rohit Bhatia; Vasantha Padma; Jayanta Roy; Suresh Subramaniam; Michael D Hill; Andrew M Demchuk; PREDICT/Sunnybrook ICH CTA Study Group

doi:10.1161/STROKEAHA.115.011295

Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

Stroke. 2016 Feb;47(2):350-5. doi: 10.1161/STROKEAHA.115.011295. Epub 2015 Dec 22.

Authors

David Rodriguez-Luna¹, Teri Stewart¹, Dar Dowlatshahi¹, Jayme C Kosior¹, Richard I Aviv¹, Carlos A Molina¹, Yolanda Silva¹, Imanuel Dzialowski¹, Cheemun Lum¹, Anna Czlonkowska¹, Jean-Martin Boulanger¹, Carlos S Kase¹, Gord Gubitz¹, Rohit Bhatia¹, Vasantha Padma¹, Jayanta Roy¹, Suresh Subramaniam¹, Michael D Hill¹, Andrew M Demchuk²; PREDICT/Sunnybrook ICH CTA Study Group

Affiliations

¹ From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.).
² From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.). ademchuk@ucalgary.ca.

PMID: 26696644
DOI: 10.1161/STROKEAHA.115.011295

Abstract

Background and purpose: Perihematomal edema volume may be related to intracerebral hemorrhage (ICH) volume at baseline and, consequently, with hematoma expansion. However, the relationship between perihematomal edema and hematoma expansion has not been well established. We aimed to investigate the relationship among baseline perihematomal edema, the computed tomographic angiography spot sign, hematoma expansion, and clinical outcome in patients with acute ICH.

Methods: Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) was a prospective observational cohort study of ICH patients presenting within 6 hours from onset. Patients underwent computed tomography and computed tomographic angiography scans at baseline and 24-hour computed tomography scan. A post hoc analysis of absolute perihematomal edema and relative perihematomal edema (absolute perihematomal edema divided by ICH) volumes was performed on baseline computed tomography scans (n=353). Primary outcome was significant hematoma expansion (>6 mL or >33%). Secondary outcomes were early neurological deterioration, 90-day mortality, and poor outcome.

Results: Absolute perihematomal edema volume was higher in spot sign patients (24.5 [11.5-41.8] versus 12.6 [6.9-22] mL; P<0.001), but it was strongly correlated with ICH volume (ρ=0.905; P<0.001). Patients who experienced significant hematoma expansion had higher absolute perihematomal edema volume (18.4 [10-34.6] versus 11.8 [6.5-22] mL; P<0.001) but similar relative perihematomal edema volume (1.09 [0.89-1.37] versus 1.12 [0.88-1.54]; P=0.400). Absolute perihematomal edema volume and poorer outcomes were higher by tertiles of ICH volume, and perihematomal edema volume did not independently predict significant hematoma expansion.

Conclusions: Perihematomal edema volume is greater at baseline in the presence of a spot sign. However, it is strongly correlated with ICH volume and does not independently predict hematoma expansion.

Keywords: computed tomographic angiography; edema; hematoma expansion; intracerebral hemorrhage; outcome; spot sign.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Brain Edema / diagnostic imaging*
Brain Edema / etiology
Cerebral Angiography
Cerebral Hemorrhage / complications
Cerebral Hemorrhage / diagnostic imaging*
Cohort Studies
Disease Progression
Female
Hematoma / diagnostic imaging*
Hematoma / etiology
Humans
Intracranial Hemorrhages / diagnostic imaging
Male
Middle Aged
Prognosis
Prospective Studies
Severity of Illness Index
Tomography, X-Ray Computed