ISC 2026 | Spot sign evolution patterns predict hematoma expansion in ICH

So we included in our study patients with acute ICH investigated with non-contrast CT and multi-phase CTA to look whether the spot sign evolution patterns were associated with hematoma expansion. And we classified the hematoma evolution expansion based on pattern 0 where there was no spot sign at all. Pattern one, when there was a spot sign, but no expansion over time across the phases of the multi-phase. Pattern two, wherever there was a circular expansion and pattern three, wherever there was a linear expansion of the spot sign. And what we found from a study of nearly 500 patients was that actually the spot sign evolution pattern improved the prediction of the hematoma expansion. And so it might be helpful to select patients for the next intervention trials. And I guess it goes along very well with the trials that are presented here in the International Stroke Conference 2026, especially with FASTEST where the authors show that there is a massive effect in the subgroup of spot sign. So we think that the spot sign evolution pattern might be helpful in the next future to select patients at the highest risk of expansion and that can benefit the most from acute interventions.

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