Spot sign

David Goldemund M.D.
Updated on 20/12/2023, published on 13/04/2021

the spot sign can be observed on post-contrast CT scans (typically CTA); it represents extravasation of contrast-enhanced blood within the hematoma
the presence of the spot sign strongly correlates with early ICH growth (Wada, 2007)
DDx of spot sign:
- AVM or aneurysm
- calcification (hyperdense on non-contrast CT scan)
- tumor

Definition of spot sign (extravasation on contrast-enhanced CT scan)
≥ 1 contrast deposit inside the hematoma with increased density compared to the surrounding hematoma density ≥ 120 HU the lesion is not related to surrounding vascular structures the lesion may be of any size and shape

the spot sign score is a valuable predictor of early hematoma expansion, in-hospital mortality, and unfavorable outcome in patients with primary ICH [Delgado Almandoz, 2009] [Havsteen, 2014]
- mortality rate based on spot sign score 2 ~ 30%, 3 ~ 50-70%, 4 ~ 70-90%, 5 ~ 100%
the absence of a spot sign on the initial CT scan, followed by hematoma progression, can be explained by rebleeding or slow bleeding (detectable only on delayed post-contrast images)

Spot Sign Score (Delgado Almandoz)
Number of spot signs 1-2 ≥ 3	1 2
Maximum dimension 1-4 mm ≥ 5 mm	0 1
Maximum density 20-179 HU ≥ 180 HU	0 1