On CT angiography of the brain performed for subarachnoid haemorrhage, the 'spot sign' within an intracerebral haematoma refers to:
- A Contrast extravasation within the haematoma predicting haematoma expansion ✓
- B A calcified focus within the clot indicating old haemorrhage
- C Absence of surrounding oedema indicating hyperacute haemorrhage
- D A small hyperdense nodule at the haematoma margin indicating an arteriovenous malformation
Correct answer: A. Contrast extravasation within the haematoma predicting haematoma expansion
Explanation
The 'spot sign' on CTA is defined as one or more foci of contrast enhancement within an acute intracerebral haematoma seen on the arterial phase. It indicates active contrast extravasation from small perforating vessels, and its presence strongly predicts haematoma expansion, higher mortality, and worse outcome. It is not calcification (calcification is present on non-contrast CT) and not a structural vascular malformation.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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