, Volume 56, Issue 7, pp 535–541 | Cite as

The extent of the perihemorrhagic perfusion zone correlates with hematoma volume in patients with lobar intracerebral hemorrhage

  • Kerim BeseogluEmail author
  • Nima Etminan
  • Bernd Turowski
  • Hans-Jakob Steiger
  • Daniel Hänggi
Diagnostic Neuroradiology



Existing data on perfusion imaging assumes the perihemorrhagic zone (PHZ) in patients with intracerebral hemorrhage (ICH) to be size steady. This study investigates the size of the perihemorrhagic zone (PHZ) in patients with lobar ICH in relation to hematoma volume during the course of treatment using perfusion CT (PCT).


The present analysis is based on a previously reported cohort of 20 patients undergoing surgical evacuation for lobar SICH, with pre- and early postoperative PCT scanning. Time to peak of the residue function (T max) was measured based on the 360° cortical banding method and singular value decomposition. The size of PHZ was determined before and after treatment and correlated with hematoma volume.


Preoperative mean hematoma volume constituted 63.0 ml (interquartile ranges (IQR) 39.7–99.4 ml), which correlated significantly (r = 0.563, p = 0.010) with mean PHZ size (5.67 cm, IQR 5.44–8.17 cm). Following a surgical hematoma evacuation, mean hematoma volume was reduced to 2.5 ml IQR 0.0–9.5 ml, which also resulted in a significant reduction of PHZ size to 0.45 cm(IQR 0.0–1.36 cm; p < 0.001). There was no association between postoperative hematoma volume and size of the PHZ.


Our findings illustrate that the extent of the PHZ cannot be generally assumed to be constant in size and that this differs significantly following hematoma reduction in patients with space occupying lobar SICH.


Intracerebral hemorrhage Perfusion CT Perihemorrhagic zone Evacuation 


Ethical standards and patient consent

We declare that all human and animal studies have been approved by the local ethics committee of the Medical Faculty of the Heinrich-Heine-University Düsseldorf, Germany, and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

We declare that we have no conflict of interest.


  1. 1.
    Anderson CS, Huang Y, Arima H et al (2010) Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke 41:307–312PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson CS, Huang Y, Wang JG et al (2008) Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 7:391–399PubMedCrossRefGoogle Scholar
  3. 3.
    Bejot Y, Cordonnier C, Durier J et al (2013) Intracerebral haemorrhage profiles are changing: results from the Dijon population-based study. Brain 136:658–664PubMedCrossRefGoogle Scholar
  4. 4.
    Broderick JP, Brott TG, Duldner JE et al (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993PubMedCrossRefGoogle Scholar
  5. 5.
    Butcher KS, Jeerakathil T, Hill M et al (2013) The intracerebral hemorrhage acutely decreasing arterial pressure trial. Stroke 44:620–626PubMedCrossRefGoogle Scholar
  6. 6.
    Diedler J, Karpel-Massler G, Sykora M et al (2010) Autoregulation and brain metabolism in the perihematomal region of spontaneous intracerebral hemorrhage: an observational pilot study. J Neurol Sci 295:16–22PubMedCrossRefGoogle Scholar
  7. 7.
    Etminan N, Beseoglu K, Turowski B et al (2012) Perfusion CT in patients with spontaneous lobar intracerebral hemorrhage: effect of surgery on perihemorrhagic perfusion. Stroke 43:759–763PubMedCrossRefGoogle Scholar
  8. 8.
    Fainardi E, Borrelli M, Saletti A et al (2008) CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage. Neuroradiology 50:729–740PubMedCrossRefGoogle Scholar
  9. 9.
    Falcone GJ, Biffi A, Brouwers HB et al (2013) Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage. JAMA Neurol 70:988–994PubMedCrossRefGoogle Scholar
  10. 10.
    Feigin VL, Lawes CM, Bennett DA et al (2009) Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 8:355–369PubMedCrossRefGoogle Scholar
  11. 11.
    Herweh C, Juttler E, Schellinger PD et al (2007) Evidence against a perihemorrhagic penumbra provided by perfusion computed tomography. Stroke 38:2941–2947PubMedCrossRefGoogle Scholar
  12. 12.
    Kirkman MA, Smith M (2013) Supratentorial intracerebral hemorrhage: a review of the underlying pathophysiology and its relevance for multimodality neuromonitoring in neurointensive care. J Neurosurg Anesthesiol 25:228–239PubMedCrossRefGoogle Scholar
  13. 13.
    Mendelow AD, Gregson BA, Rowan EN et al (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382:397–408PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Olivot JM, Mlynash M, Zaharchuk G et al (2009) Perfusion MRI (Tmax and MTT) correlation with xenon CT cerebral blood flow in stroke patients. Neurology 72:1140–1145PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Orakcioglu B, Becker K, Sakowitz OW et al (2008) MRI of the perihemorrhagic zone in a rat ICH model: effect of hematoma evacuation. Neurocrit Care 8:448–455PubMedCrossRefGoogle Scholar
  16. 16.
    Pascual AM, Lopez-Mut JV, Benlloch V et al (2007) Perfusion-weighted magnetic resonance imaging in acute intracerebral hemorrhage at baseline and during the 1st and 2nd week: a longitudinal study. Cerebrovasc Dis 23:6–13PubMedCrossRefGoogle Scholar
  17. 17.
    Rosand J, Eskey C, Chang Y et al (2002) Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage. Cerebrovasc Dis 14:214–220PubMedCrossRefGoogle Scholar
  18. 18.
    Schellinger PD, Fiebach JB, Hoffmann K et al (2003) Stroke MRI in intracerebral hemorrhage: is there a perihemorrhagic penumbra? Stroke 34:1674–1679PubMedCrossRefGoogle Scholar
  19. 19.
    Van Asch CJ, Luitse MJ, Rinkel GJ et al (2010) Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9:167–176PubMedCrossRefGoogle Scholar
  20. 20.
    Wittsack HJ, Wohlschlager AM, Ritzl EK et al (2008) CT-perfusion imaging of the human brain: advanced deconvolution analysis using circulant singular value decomposition. Comput Med Imaging Graph 32:67–77PubMedCrossRefGoogle Scholar
  21. 21.
    Zazulia AR, Diringer MN, Videen TO et al (2001) Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 21:804–810PubMedCrossRefGoogle Scholar
  22. 22.
    Zhou J, Zhang H, Gao P et al (2010) Assessment of perihematomal hypoperfusion injury in subacute and chronic intracerebral hemorrhage by CT perfusion imaging. Neurol Res 32:642–649PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kerim Beseoglu
    • 1
    Email author
  • Nima Etminan
    • 1
  • Bernd Turowski
    • 2
  • Hans-Jakob Steiger
    • 1
  • Daniel Hänggi
    • 1
  1. 1.Department of Neurosurgery, Medical FacultyHeinrich-Heine-Universität DüsseldorfDüsseldorfGermany
  2. 2.Department of Diagnostic and Interventional Radiology, Medical FacultyHeinrich-Heine-Universität DüsseldorfDüsseldorfGermany

Personalised recommendations