Spot sign

Created 13/04/2021, last revision 17/05/2022

  • the spot sign can be detected on post-contrast CT scans (typically CTA), it represents extravasation of contrast containing blood within the hematoma
  • the presence of the spot sign highly 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 can have any size and shape
Spot sign
Parenchymal hematoma on NCCT (left), spot sign on CT angiography (right)
Spot sign on CTA

  • the spot sign score is a valuable predictor of early hematoma expansion and a predictor of in-hospital mortality and poor outcome among survivors in patients with primary ICH Dependence of Spot Sign Score and outcome [Delgado, 2010] [Delgado Almandoz, 2009]   [Havsteen, 2014] 
    • mortality of patients with spot sign score 2 ~ 30%, 3 ~ 50-70%, 4 ~ 70-90%, 5 ~ 100%
  • absence of spot sign on initial CT scan with subsequent hematoma progression can be explained by rebleeding or slow bleeding (detectable on delayed postcontrast images only)
Spot Sign Score (Delgado Almandoz)
Number of spot signs
≥ 3
Maximum dimension
1-4 mm
≥ 5 mm
Maximum density
20-179 HU
≥ 180 HU
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