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Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A0859v1 29/3/520 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kim, J. Articles by Wintermark, M. Search for Related Content PubMed PubMed Citation Articles by Kim, J. Articles by Wintermark, M. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:520-525, March 2008 © 2008 American Society of Neuroradiology BRAIN Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage J. Kim a , A. Smith a , J.C. Hemphill, III b , W.S. Smith b , Y. Lu a , W.P. Dillon a and M. Wintermark a a Departments of Radiology, Neuroradiology Section, University of California, San Francisco, San Francisco, Calif b Department of Neurology, University of California, San Francisco, San Francisco, Calif Please address correspondence to Max Wintermark, MD, Department of Radiology, Neuroradiology Section, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; e-mail: Max.Wintermark@radiology.ucsf.edu BACKGROUND AND PURPOSE: Recent studies of intracerebral hemorrhage (ICH) treatments have highlighted the need to identify reliable predictors of hematoma expansion. The goal of this study was to determine whether contrast extravasation on multisection CT angiography (CTA) and/or contrast-enhanced CT (CECT) of the brain is associated with hematoma expansion and increased mortality in patients with primary ICH. MATERIALS AND METHODS: All patients with primary ICH who underwent CTA and CECT, as well as follow-up noncontrast CT (NCCT) before discharge/death from January 1, 2003, to September 30, 2005, were retrospectively identified. One neuroradiologist reviewed admission and follow-up NCCT for hematoma size and growth. A second neuroradiologist independently reviewed CTA and CECT for active contrast extravasation. Univariate and multivariate logistic regression analyses were performed to evaluate the significance of clinical and radiologic variables in predicting 30-day mortality, designated as the primary outcome. Hematoma growth was considered as a secondary outcome. RESULTS: Of 56 patients, contrast extravasation was seen in 17.9% of patients on initial CTA and in 23.2% of patients on initial CECT following CTA. Univariate analysis showed that the presence of extravasation on CT, large initial hematoma size (>30 mL), the presence of "swirl sign" on NCCT, the Glasgow Coma Scale and ICH scores, and international normalized ratio were associated with increased mortality. On multivariate analysis, only contrast extravasation on CT ( P = .017) independently predicted mortality. Contrast extravasation on CT ( P < .001) was also an independent predictor of hematoma growth on multivariate analysis. CONCLUSION: Active contrast extravasation on CT in patients with primary ICH independently predicts mortality and hematoma growth. This article has been cited by other articles: J. E. Delgado Almandoz, A. J. Yoo, M. J. Stone, P. W. Schaefer, A. Oleinik, H. B. Brouwers, J. N. Goldstein, J. Rosand, M. H. Lev, R. G. Gonzalez, et al. The Spot Sign Score in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk of In-Hospital Mortality and Poor Outcome Among Survivors Stroke, January 1, 2010; 41(1): 54 - 60. Abstract Full Text PDF J. E. Delgado Almandoz, A. J. Yoo, M. J. Stone, P. W. Schaefer, J. N. Goldstein, J. Rosand, A. Oleinik, M. H. Lev, R. G. Gonzalez, and J. M. Romero Systematic Characterization of the Computed Tomography Angiography Spot Sign in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk for Hematoma Expansion: The Spot Sign Score Stroke, September 1, 2009; 40(9): 2994 - 3000. Abstract Full Text PDF A. Oleinik, J. M. Romero, K. Schwab, M. H. Lev, N. Jhawar, J. E. Delgado Almandoz, E. E. Smith, S. M. Greenberg, J. Rosand, and J. N. Goldstein CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy Stroke, July 1, 2009; 40(7): 2393 - 2397. Abstract Full Text PDF M. Wintermark, H. A. Rowley, and M. H. Lev Acute Stroke Triage to Intravenous Thrombolysis and Other Therapies with Advanced CT or MR Imaging: Pro CT Radiology, June 1, 2009; 251(3): 619 - 626. Full Text PDF A. Ederies, A. Demchuk, T. Chia, D. J. Gladstone, D. Dowlatshahi, G. BenDavit, K. Wong, S. P. Symons, and R. I. Aviv Postcontrast CT Extravasation Is Associated With Hematoma Expansion in CTA Spot Negative Patients Stroke, May 1, 2009; 40(5): 1672 - 1676. Abstract Full Text PDF C. D. Barras, B. M. Tress, S. Christensen, L. MacGregor, M. Collins, P. M. Desmond, B. E. Skolnick, S. A. Mayer, J. P. Broderick, M. N. Diringer, et al. Density and Shape as CT Predictors of Intracerebral Hemorrhage Growth Stroke, April 1, 2009; 40(4): 1325 - 1331. Abstract Full Text PDF S. A. Mayer, S. M. Davis, B. E. Skolnick, N. C. Brun, K. Begtrup, J. P. Broderick, M. N. Diringer, and T. Steiner Can a Subset of Intracerebral Hemorrhage Patients Benefit From Hemostatic Therapy With Recombinant Activated Factor VII? Stroke, March 1, 2009; 40(3): 833 - 840. Abstract Full Text PDF R.I. Aviv, D. Gladstone, J. Goldstein, M. Flaherty, J. Broderick, A. Demchuk, and for the Spot Sign for Predicting and Treating ICH Contrast Extravasation Predicts Hematoma Growth: Where to Now? AJNR Am. J. Neuroradiol., October 1, 2008; 29(9): e80 - e80. Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A0859
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Abstract

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A0859v1 29/3/520 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kim, J. Articles by Wintermark, M. Search for Related Content PubMed PubMed Citation Articles by Kim, J. Articles by Wintermark, M. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:520-525, March 2008 © 2008 American Society of Neuroradiology BRAIN Contrast Extravasation on CT Predicts Mortality in Primary Intracerebral Hemorrhage J. Kim a , A. Smith a , J.C. Hemphill, III b , W.S. Smith b , Y. Lu a , W.P. Dillon a and M. Wintermark a a Departments of Radiology, Neuroradiology Section, University of California, San Francisco, San Francisco, Calif b Department of Neurology, University of California, San Francisco, San Francisco, Calif Please address correspondence to Max Wintermark, MD, Department of Radiology, Neuroradiology Section, University of California, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; e-mail: Max.Wintermark@radiology.ucsf.edu BACKGROUND AND PURPOSE: Recent studies of intracerebral hemorrhage (ICH) treatments have highlighted the need to identify reliable predictors of hematoma expansion. The goal of this study was to determine whether contrast extravasation on multisection CT angiography (CTA) and/or contrast-enhanced CT (CECT) of the brain is associated with hematoma expansion and increased mortality in patients with primary ICH. MATERIALS AND METHODS: All patients with primary ICH who underwent CTA and CECT, as well as follow-up noncontrast CT (NCCT) before discharge/death from January 1, 2003, to September 30, 2005, were retrospectively identified. One neuroradiologist reviewed admission and follow-up NCCT for hematoma size and growth. A second neuroradiologist independently reviewed CTA and CECT for active contrast extravasation. Univariate and multivariate logistic regression analyses were performed to evaluate the significance of clinical and radiologic variables in predicting 30-day mortality, designated as the primary outcome. Hematoma growth was considered as a secondary outcome. RESULTS: Of 56 patients, contrast extravasation was seen in 17.9% of patients on initial CTA and in 23.2% of patients on initial CECT following CTA. Univariate analysis showed that the presence of extravasation on CT, large initial hematoma size (>30 mL), the presence of "swirl sign" on NCCT, the Glasgow Coma Scale and ICH scores, and international normalized ratio were associated with increased mortality. On multivariate analysis, only contrast extravasation on CT ( P = .017) independently predicted mortality. Contrast extravasation on CT ( P < .001) was also an independent predictor of hematoma growth on multivariate analysis. CONCLUSION: Active contrast extravasation on CT in patients with primary ICH independently predicts mortality and hematoma growth. This article has been cited by other articles: J. E. Delgado Almandoz, A. J. Yoo, M. J. Stone, P. W. Schaefer, A. Oleinik, H. B. Brouwers, J. N. Goldstein, J. Rosand, M. H. Lev, R. G. Gonzalez, et al. The Spot Sign Score in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk of In-Hospital Mortality and Poor Outcome Among Survivors Stroke, January 1, 2010; 41(1): 54 - 60. Abstract Full Text PDF J. E. Delgado Almandoz, A. J. Yoo, M. J. Stone, P. W. Schaefer, J. N. Goldstein, J. Rosand, A. Oleinik, M. H. Lev, R. G. Gonzalez, and J. M. Romero Systematic Characterization of the Computed Tomography Angiography Spot Sign in Primary Intracerebral Hemorrhage Identifies Patients at Highest Risk for Hematoma Expansion: The Spot Sign Score Stroke, September 1, 2009; 40(9): 2994 - 3000. Abstract Full Text PDF A. Oleinik, J. M. Romero, K. Schwab, M. H. Lev, N. Jhawar, J. E. Delgado Almandoz, E. E. Smith, S. M. Greenberg, J. Rosand, and J. N. Goldstein CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy Stroke, July 1, 2009; 40(7): 2393 - 2397. Abstract Full Text PDF M. Wintermark, H. A. Rowley, and M. H. Lev Acute Stroke Triage to Intravenous Thrombolysis and Other Therapies with Advanced CT or MR Imaging: Pro CT Radiology, June 1, 2009; 251(3): 619 - 626. Full Text PDF A. Ederies, A. Demchuk, T. Chia, D. J. Gladstone, D. Dowlatshahi, G. BenDavit, K. Wong, S. P. Symons, and R. I. Aviv Postcontrast CT Extravasation Is Associated With Hematoma Expansion in CTA Spot Negative Patients Stroke, May 1, 2009; 40(5): 1672 - 1676. Abstract Full Text PDF C. D. Barras, B. M. Tress, S. Christensen, L. MacGregor, M. Collins, P. M. Desmond, B. E. Skolnick, S. A. Mayer, J. P. Broderick, M. N. Diringer, et al. Density and Shape as CT Predictors of Intracerebral Hemorrhage Growth Stroke, April 1, 2009; 40(4): 1325 - 1331. Abstract Full Text PDF S. A. Mayer, S. M. Davis, B. E. Skolnick, N. C. Brun, K. Begtrup, J. P. Broderick, M. N. Diringer, and T. Steiner Can a Subset of Intracerebral Hemorrhage Patients Benefit From Hemostatic Therapy With Recombinant Activated Factor VII? Stroke, March 1, 2009; 40(3): 833 - 840. Abstract Full Text PDF R.I. Aviv, D. Gladstone, J. Goldstein, M. Flaherty, J. Broderick, A. Demchuk, and for the Spot Sign for Predicting and Treating ICH Contrast Extravasation Predicts Hematoma Growth: Where to Now? AJNR Am. J. Neuroradiol., October 1, 2008; 29(9): e80 - e80. Full Text PDF Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

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American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Mar 1, 2008

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