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Primary intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality, where hematoma expansion (HE) stands as a major determinant of patient outcome. Early and accurate identification of patients at high risk for HE is paramount for timely therapeutic intervention and optimizing clinical management strategies. The Spot sign, visualized on computed tomography angiography (CTA), and its derived metric, the Spot sign score (SSS), have emerged as promising radiological biomarkers for predicting HE. However, their specific predictive value, particularly within diverse clinical contexts such as Vietnam, necessitates further investigation. This study aims to meticulously assess the efficacy of the Spot sign and SSS in forecasting hematoma expansion in primary ICH patients, thereby contributing valuable evidence to enhance clinical practice and treatment optimization.

Neurologists, neurosurgeons, radiologists, emergency physicians, medical researchers, and advanced medical students with an interest in acute stroke management, particularly primary intracerebral hemorrhage and imaging biomarkers.

This study rigorously evaluated the predictive utility of the Spot sign and the Spot sign score (SSS) detected via computed tomography angiography (CTA), alongside other clinical factors, for identifying hematoma expansion (HE) in patients afflicted with primary intracerebral hemorrhage (ICH). Adopting a comprehensive retrospective, prospective, and cross-sectional descriptive design, the research encompassed 116 ICH patients treated at Military Hospital 103 between January 2023 and April 2025. Patients underwent CTA within six hours of symptom onset, with follow-up CT scans performed within seven days to ascertain HE. The presence of the Spot sign and the calculation of the SSS were meticulously determined according to established criteria, and their predictive performance was assessed using sensitivity, specificity, AUC values, and multivariate regression analysis.The findings revealed that the Spot sign demonstrated a sensitivity of 68.75% and a specificity of 71.43% in predicting HE. The maximum transverse diameter of the Spot sign yielded an Area Under the Curve (AUC) of 0.699 (p = 0.021), while the SSS achieved an AUC of 0.708 (p = 0.016). Importantly, multivariate regression analysis pinpointed admission Glasgow Coma Scale (GCS) scores, NIHSS scores, the Spot sign, and the SSS as independent predictors of HE. Notably, the SSS emerged as the most potent predictor, with a robust odds ratio of 8.743 (p = 0.009). These results emphatically underscore the significant role of both the Spot sign and, particularly, the SSS, as reliable indicators for predicting hematoma expansion in primary ICH. Integrating these validated markers into clinical protocols can substantially aid in the early identification of high-risk patients, facilitating more aggressive and individualized management strategies to curtail hematoma growth and ultimately improve patient prognosis and clinical outcomes.