Abstract Purpose The Spot Sign (SS) is a radiological finding on computed tomography angiography (CTA) in patients with intracerebral hemorrhage (ICH). This meta-analysis aimed to evaluate the association between the SS and both hematoma expansion (HE) and functional outcomes by comparing ICH patients with and without SS. Methods We searched PubMed, Embase and Cochrane Library for studies of intracranial hemorrhage reporting the SS. The primary outcomes examined were functional status and hematoma expansion, secondary outcomes were mortality and initial hematoma volume. Statistical analysis was performed using RStudio (version 4.5.2), and heterogeneity was assessed with I² statistics. In addition, sensitivity analyses were performed, and publication bias was assessed through funnel plots and Egger’s regression test. Results We included 10 observational studies with a total of 2,832 patients with spontaneous ICH. Of these, 613 had SS, while 2,219 did not. The mean age was 66.31 ± 13.81 and 1,367 (58.6%) were male. Poor functional outcomes (OR 4.06, 95% CI 2.66─6.20, p < 0.0001, I² = 0.0%) and hematoma expansion (OR 7.17, 95% CI: 5.65─9.09, p < 0.0001, I² = 0.0%) were substantially higher in patients with SS, as well as the overall mortality rate (OR 4.14, 95% CI 2.45–6.99, p < 0.0001, I² = 65.4%). However, the initial hematoma volume (MD 11.54, 95% CI -11.43─34.52, p = 0.2082, I² = 80.1%) was not statistically different between groups. Furthermore, the leave-one-out sensitivity analyses showed that no single study exerted a disproportionate influence on the overall effect for the examined outcomes, and Egger’s linear regression tests were not statistically significant for both primary outcomes. Conclusion The presence of the SS is associated with higher rates of poor functional outcomes and hematoma expansion. Therefore, the SS represents a relevant radiological marker with potential to support early risk stratification and optimize patient management and treatment selection.
Cardoso et al. (Wed,) studied this question.