CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage
We sought to quantify perfusion changes associated to acute spontaneous intracerebral hemorrhage (SICH) by means of computed tomography perfusion (CTP) imaging.
Materials and methods
We studied 89 patients with supratentorial SICH at admission CT by using CTP scanning obtained within 24 h after symptom onset. Regional cerebral blood flow (rCBF), cerebral blood volume (rCBV) and mean transit time (rMTT) levels were measured in four different regions of interest manually outlined on CT scan: (1) hemorrhagic core; (2) perihematomal low-density area; (3) 1 cm rim of normal-appearing brain tissue surrounding the perilesional area; and (4) a mirrored area, including the clot and the perihematomal region, located in the non-lesioned contralateral hemisphere.
rCBF, rCBV, and rMTT mean levels showed a centrifugal distribution with a gradual increase from the core to the periphery (p < 0.0001). Perfusion absolute values were indicative of ischemia in hemorrhagic core, oligemia in perihematomal area, and hyperemia in normal-appearing and contralateral areas. Perihematomal rCBF and rCBV mean levels were higher in small (≤20 ml) than in large (>20 ml) hematomas (p < 0.01 and p < 0.02, respectively).
Multi-parametric CTP mapping of acute SICH indicates that perfusion values show a progressive improvement from the core to the periphery. In the first 24 h, perihemorrhagic region was hypoperfused with CTP values which were not suggestive of ischemic penumbra destined to survive but more likely indicative of edema formation. These findings also argue for a potential influence of early amounts of bleeding on perihematomal hemodynamic abnormalities.
KeywordsAcute spontaneous intracerebral hemorrhage Perfusion values CT perfusion Brain edema
This study was supported by Azienda Ospedaliera Universitaria, Ferrara. We thank Professor Julian T. Hoff of Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan (USA), and Doctor Howard Yonas of Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico (USA), for comments and critical review of the manuscript.
Conflict of interest statement
We declare that we have no conflict of interest.
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