Abstract Body: Background: Intracerebral hemorrhage (ICH) is a critical neurological condition with high rates of mortality and morbidity. Accurate prediction of the clinical outcomes in ICH patients is essential for effective clinical management. Intravenous contrast extravasation, also known as spot sign, identified in conventional vascular imaging, has emerged as a significant radiological marker associated with hematoma expansion, potentially influencing mortality and functional outcomes.
Aim: We aim to elucidate the predictive value of the spot sign for mortality and poor functional outcomes in patients with ICH.
Methods: We searched for studies in PubMed, Embase, and Cochrane Library databases. Our inclusion criteria focused on studies assessing mortality and poor functional outcomes (mRS score 3-6) in adult groups with and without a sign spot in head imaging after ICH. We pooled the odds ratio (OR) for both outcomes using random effects and assessed publication bias through Egger’s test, adjusting while using trim-and-fill analysis. Heterogeneity was measured through I². We also conducted bivariate random-effects models using Bayesian Information Criteria (BIC) to determine pooled sensitivity and specificity for both outcomes. Results are presented with a 95% Confidence Interval (CI).
Results: We included 29 studies comprising 4,597 patients, with a mortality and poor functional outcomes rates of 21.2% and 47.8%, respectively. Spot sign was consistently identified as a robust predictor of outcomes across multiple studies. For mortality, the pooled specificity was 0.821 (95% CI [0.782-0.855]; I²=23.44%) with low sensitivity at 0.468 (95% CI [0.391-0.547]; I²=32.3%). For poor functional outcomes, the specificity was 0.876 (95% CI [0.815-0.920]; I²=48.5%), and the sensitivity was 0.369 (95% CI [0.295-0.451; I²=32.7%). Spot sign significantly increased the odds of both outcomes. After adjusting for publication bias, the OR for mortality was 3.37 (95% CI: 2.41-4.71; I²=73.2%). For poor functional outcomes, OR was 4.13 (95% CI: 3.15-5.42; I²=33%).
Conclusion: Spot sign visualized in conventional vascular imaging is a highly specific radiological biomarker for predicting mortality and poor functional outcomes in patients with ICH. Recognizing this sign should prompt immediate yet targeted interventions to improve patient survival and recovery. However, fully adopting this biomarker for mortality outcome prediction requires further analysis of heterogeneity sources.