The Predictive Value Of CTA Spot Sign On The Enlargement Of Hematoma In Patients With HICH Whose Of Onset Time More Than 6 Hours

Objective: To determine whether computed tomography angiography(CTA)spot sign is still effective in predicting hematoma enlargement when the onset time ranges from 6 to 24 hours.Methods: 56 cases with acute hypertensive cerebral hemorrhage(HICH)who sought medical advice in the neurology or emergency department of Qinghai People's Hospital from January 2015 to December 2016.The inclusion criteria were as follows:those whose onset time ranged from 6 to 24 hours and completed CT examination of the head 1 hour after admission,whose CTA scanning time was within 6 hours after admission without contraindications against contrast agent(for example,hypersensitivity to,renal dysfunction,etc.),and whose re-examination time of CT examination of the head were 6 to 30 hours after onset.Hematoma volume was calculated in accordance with ABC/2 formula to make a comparative analysis of the correlation of spot sign positive and negative patients with the incidence rate of later hematoma enlargement.Results:(1)An analysis of the CTA original images of the 56 patients enrolled showed that there were 13 patients(23.2%)with positive spot sign and 43 patients(76.8%)with negative spot sign.The statistical analysis of the two groups(positive group and negative group)in terms of gender,bleeding part,age,GCS score and first CT hematoma volume data found that there were no statistically significant differences between the two groups in terms of the above indicators(P>0.05).(2)An statistical analysis of the hematoma enlargement rates of the two groups revealed that there was a statistically significant difference between the two groups in hematoma enlargement rate(x2=22.02,P<0.05).The hematoma volumes of the two groups at the initial examination and the reexamination suggested that there was a statistically significant difference in the hematoma volumes of spot sign negative patients between the initial examination and the reexamination(P<0.05),while there was no statistically significant difference in the hematoma volumes of spot sign negative patients between the initial examination and the reexamination(P>0.05).(3)The sensitivity of CTA spot sign to diagnosis of hematoma enlargement was 80% (8/10),its accuracy was 87.5%(49/56),its specificity was 89.1%(41/46),its positive predicative value was 61.5%(8/13),and its negative predicative value was 95.3%(41/43).10 patients(10/56,17.9%)suffered from hematoma enlargement,including 8cases with positive spot sign(8/13,61.5%)and 2 cases with negative spot sign(2/43,4.7%).Conclusions:(1)Hematoma enlargement is common in HICH patients whose onset time is greater than 6 hours.(2)For HICH patients whose acute onset time exceeds 6hours,CTA imaging spot sign have a good value for predicting later hematoma enlargement.