CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 045-052
DOI: 10.1055/s-0043-1764327
Original Article

Potential of Satellite Sign for Prediction of Hematoma Expansion in Small Spontaneous Hematoma within 7 Days' Follow-Up

Dittapong Songsaeng
1   Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Wassana Peuksiripibul
1   Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Jitladda Wasinrat
1   Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chulaluck Boonma
1   Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Patnaree Wongjaroenkit
2   GE Healthcare, Bangkok, Thailand
› Author Affiliations


Background Hematoma expansion (HE) is the most important modifiable predictor that can change the clinical outcome of intracerebral hemorrhage (ICH) patients. The study aimed to investigate the potential of satellite sign for prediction of HE in spontaneous ICH patients who had follow-up non-contrast computed tomography (NCCT) within 7 days after the initial CT scan.

Methods We retrospectively reviewed data and NCCT from 142 ICH patients who were treated at our hospital at Bangkok, Thailand. All included patients were treated conservatively, had baseline NCCT within 12 hours after symptom onset, and had follow-up NCCT within 168 hours after baseline NCCT. HE was initially estimated by two radiologists, and then by image analysis software. Association between satellite sign and HE was evaluated.

Results HE occurred in 45 patients (31.7%). Patients with HE had significantly higher activated partial thromboplastin time (p = 0.001) and baseline hematoma volume (p = 0.001). The prevalence of satellite sign was 43.7%, and it was significantly independently associated with HE (p = 0.021). The sensitivity, specificity, and accuracy of satellite sign for predicting HE was 57.8, 62.9, and 61.3%, respectively. From image analysis software, the cutoff of greater than 9% relative growth in hematoma volume on follow-up NCCT had the highest association with satellite sign (p = 0.024), with a sensitivity of 55%, specificity of 64.6%, and accuracy of 60.5%.

Conclusion Satellite sign, a new NCCT predictor, was found to be significantly associated with HE in Thai population. With different context of Thai population, HE was found in smaller baseline hematoma volume. Satellite sign was found more common in lobar hematoma. Further studies to validate satellite sign for predicting HE and to identify an optimal cutoff in Thai population that is correlated with clinical outcomes are warranted.

Ethics Approval

The protocol for this study was approved by the Siriraj Institutional Review Board (SIRB) (COA no. 737/2561) of Mahidol University that was certified and is in full compliance with international guidelines for human research protection such as the Declaration of Helsinki, the Belmont Report, CIOMS Guidelines, and the international Conference on Harmonization in Good Clinical Practice (ICH-GCP). The requirement to obtain written informed consent was waived due to the retrospective nature of this study.

Publication History

Article published online:
27 March 2023

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