Vascular and Nonvascular Mimics of the CT Angiography “Spot Sign” in Patients With Secondary Intracerebral Hemorrhage

Background and Purpose— The newly-described computed tomography angiography (CTA) Spot Sign is present in about one third of patients with acute primary intracerebral hemorrhage (PICH) and predicts hematoma expansion. This sign has not been systematically evaluated in patients with secondary causes of ICH, and mimics have not been characterized. The purpose of this study was to assess for the presence of the Spot Sign in secondary ICH and to document potential mimics of the Spot Sign and their distinguishing features. Methods— We performed a retrospective chart review of consecutive patients presenting with ICH to our regional stroke center between January 2002 and May 2007. Ninety-six ICH patients underwent a CT stroke protocol including CTA. CTA documented a secondary cause for hemorrhage in 30 patients (31%). Each patient was assessed for the presence or absence of the CTA Spot Sign or a mimic by 2 blinded neuroradiologists. Clinical and radiological features of PICH and secondary ICH were compared. Re...