CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage

• Published in: Neuroradiology Vol. 50; no. 8; pp. 729 - 740
• Main Authors: Fainardi, Enrico, Borrelli, Massimo, Saletti, Andrea, Schivalocchi, Roberta, Azzini, Cristiano, Cavallo, Michele, Ceruti, Stefano, Tamarozzi, Riccardo, Chieregato, Arturo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2008; Springer; Springer Nature B.V
• Subjects: Aged; Biological and medical sciences; Blood Flow Velocity - physiology; Blood Volume; Brain; Brain Edema - diagnostic imaging; Brain Edema - etiology; Brain Edema - physiopathology; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - physiopathology; Cerebrovascular Circulation - physiology; Electrodiagnosis. Electric activity recording; Female; Functional Neuroradiology; Hemorrhage; Humans; Imaging; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nervous system; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; Reproducibility of Results; Tomography; Tomography, X-Ray Computed - methods; Brain edema; CT perfusion; Perfusion values; Acute spontaneous intracerebral hemorrhage; Cartography; Nervous system diseases; Radiodiagnosis; Central nervous system; Intracerebral; Hemorrhage; Cerebral disorder; Encephalon; Acute spontaneous intracerebral hemorrhage Perfusion values; Central nervous system disease; Computerized axial tomography; Hemodynamics; Cerebral edema
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-008-0402-x

Introduction 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. Results 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). Conclusion 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.