European Radiology

, Volume 28, Issue 10, pp 4343–4349 | Cite as

Iodine concentration: a new, important characteristic of the spot sign that predicts haematoma expansion

  • Fan Fu
  • Shengjun SunEmail author
  • Liping Liu
  • Jianying Li
  • Yaping Su
  • Yingying Li



The computed tomography angiography (CTA) spot sign is a validated predictor of haematoma expansion (HE) in spontaneous intracerebral haemorrhage (SICH). We investigated whether defining the iodine concentration (IC) inside the spot sign and the haematoma on Gemstone spectral imaging (GSI) would improve its sensitivity and specificity for predicting HE.


From 2014 to 2016, we prospectively enrolled 65 SICH patients who underwent single-phase spectral CTA within 6 h. Logistic regression was performed to assess the risk factors for HE. The predictive performance of individual spot sign characteristics was examined via receiver operating characteristic (ROC) analysis.


The spot sign was detected in 46.1% (30/65) of patients. ROC analysis indicated that IC inside the spot sign had the greatest area under the ROC curve for HE (0.858; 95% confidence interval, 0.727–0.989; p = 0.003). Multivariate analysis found that spot sign with higher IC (i.e. IC > 7.82 100 μg/ml) was an independent predictor of HE (odds ratio = 34.27; 95% confidence interval, 5.608–209.41; p < 0.001) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 0.81, 0.75, 0.90 and 0.60, respectively; while the spot sign showed sensitivity, specificity, PPV and NPV of 0.81, 0.79, 0.73 and 0.86. Logistic regression analysis indicated that the IC in haematomas was independently associated with HE (odds ratio = 1.525; 95% confidence interval, 1.041–2.235; p = 0.030).


ICs in haematoma and in spot sign were all independently associated with HE. IC analysis in spectral imaging may help to identify SICH patients for targeted haemostatic therapy.

Key Points

• Iodine concentration in spot sign and haematoma can predict haematoma expansion

• Spectral imaging could measure the IC inside the spot sign and haematoma

• IC in spot sign improved the positive predictive value (PPV) cf. CTA


CT angiography Cerebral haemorrhage Iodine Concentration Haematoma 



Activated partial thromboplastin time


Gemstone spectral imaging


Haematoma expansion


Iodine concentration


International normalised radio


Non-contrast CT


National Institute of Health Stoke Scale


Spontaneous intracerebral haemorrhage



This study has received funding by Beijing Municipal Natural Science Foundation.

Compliance with ethical standards


The scientific guarantor of this publication is Shengjun Sun.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yuesong Pan kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Fan Fu
    • 1
  • Shengjun Sun
    • 2
    Email author
  • Liping Liu
    • 1
  • Jianying Li
    • 3
  • Yaping Su
    • 1
  • Yingying Li
    • 1
  1. 1.Neuroradiology DepartmentBeijing Tiantan Hospital, Capital Medical UniversityBeijingChina
  2. 2.Neuroradiology DepartmentBeijing Neurosurgical InstituteBeijingChina
  3. 3.Healthcare ChinaBeijingChina

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