Fainardi Enrico, Borrelli Massimo, Saletti Andrea, Schivalocchi Roberta, Azzini Cristiano, Cavallo Michele, Ceruti Stefano, Tamarozzi Riccardo, Chieregato Arturo
Neuroradiology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Corso della Giovecca 203, 44100, Ferrara, Italy.
Neuroradiology. 2008 Aug;50(8):729-40. doi: 10.1007/s00234-008-0402-x. Epub 2008 May 27.
We sought to quantify perfusion changes associated to acute spontaneous intracerebral hemorrhage (SICH) by means of computed tomography perfusion (CTP) imaging.
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 (< or = 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.
我们试图通过计算机断层扫描灌注（CTP）成像来量化与急性自发性脑出血（SICH）相关的灌注变化。
我们对89例幕上SICH患者进行了研究，在症状发作后24小时内对其进行入院CT检查，并使用CTP扫描。在CT扫描上手动勾勒出四个不同的感兴趣区域，测量局部脑血流量（rCBF）、脑血容量（rCBV）和平均通过时间（rMTT）水平：（1）出血核心；（2）血肿周围低密度区；（3）病变周围区域周围1厘米正常脑组织边缘；（4）位于对侧非病变半球的镜像区域，包括血凝块和血肿周围区域。
rCBF、rCBV和rMTT平均水平呈离心分布，从核心到周边逐渐升高（p < 0.0001）。灌注绝对值表明出血核心区缺血、血肿周围区血供减少以及正常和对侧区域充血。小血肿（≤20 ml）的血肿周围rCBF和rCBV平均水平高于大血肿（>20 ml）（分别为p < 0.01和p < 0.02）。
急性SICH的多参数CTP图谱表明，灌注值从核心到周边呈逐渐改善趋势。在最初24小时内，血肿周围区域灌注不足，CTP值不提示有注定存活的缺血半暗带，而更可能提示水肿形成。这些发现也表明早期出血量对血肿周围血流动力学异常可能有潜在影响。
