Spot sign

Created 13/04/2021, last revision 19/01/2023

  • the spot sign can be seen on post-contrast CT scans (typically CTA); it represents extravasation of contrast-enhanced 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 may be of any size and shape

Spot sign score

  • 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 a spot sign on the initial CT scan with subsequent 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
≥ 3
Maximum dimension
1-4 mm
≥ 5 mm
Maximum density
20-179 HU
≥ 180 HU
Spot sign
Spot sign on baseline CTA
Parenchymal hematoma on NCCT (left), spot sign on CT angiography (right)
Spot sign on CTA

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Spot sign