Multiphase CT angiography spot sign identifies more intracerebral hemorrhage patients at risk for hematoma expansion

A multiphase CT angiography spot sign identified high-risk intracerebral hemorrhage: hematoma expansion occurred in 25/51 (49%) phase-1, 13/28 (46%) phase-2, and 4/9 (44%) phase-3 spots versus 12/71 (17%) with no spot sign.

• Single-center cohort of 159 patients with acute intracerebral hemorrhage who had admission noncontrast CT, multiphase CT angiography, and follow-up CT within 72 hours.
• A spot sign was detected in 88/159 patients (55%); 28 first appeared in phase 2 and 9 first appeared in phase 3, a group single-phase CTA could miss.
• In patients with hematoma expansion, spots were larger, had higher attenuation, and were more numerous at first appearance; increases in spot number, volume, and attenuation on subsequent phases were also associated with expansion.

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