Stanford Neurocritical Care Program, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA.
J Am Heart Assoc. 2013 May 24;2(3):e000161. doi: 10.1161/JAHA.113.000161.
Spontaneous intracerebral hemorrhage (ICH) is associated with blood-brain barrier (BBB) injury, which is a poorly understood factor in ICH pathogenesis, potentially contributing to edema formation and perihematomal tissue injury. We aimed to assess and quantify BBB permeability following human spontaneous ICH using dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). We also investigated whether hematoma size or location affected the amount of BBB leakage.
Twenty-five prospectively enrolled patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were examined using DCE MRI at 1 week after symptom onset. Contrast agent dynamics in the brain tissue and general tracer kinetic modeling were used to estimate the forward leakage rate (K(trans)) in regions of interest (ROI) in and surrounding the hematoma and in contralateral mirror-image locations (control ROI). In all patients BBB permeability was significantly increased in the brain tissue immediately adjacent to the hematoma, that is, the hematoma rim, compared to the contralateral mirror ROI (P<0.0001). Large hematomas (>30 mL) had higher K(trans) values than small hematomas (P<0.005). K(trans) values of lobar hemorrhages were significantly higher than the K(trans) values of deep hemorrhages (P<0.005), independent of hematoma volume. Higher K(trans) values were associated with larger edema volumes.
BBB leakage in the brain tissue immediately bordering the hematoma can be measured and quantified by DCE MRI in human ICH. BBB leakage at 1 week is greater in larger hematomas as well as in hematomas in lobar locations and is associated with larger edema volumes.
自发性脑出血（ICH）与血脑屏障（BBB）损伤有关，后者是 ICH 发病机制中一个尚未充分了解的因素，可能导致水肿形成和血肿周围组织损伤。我们旨在使用动态对比增强磁共振成像（DCE MRI）评估和量化人自发性 ICH 后 BBB 的通透性。我们还研究了血肿大小或位置是否影响 BBB 渗漏量。
前瞻性纳入来自自发性脑出血的 MRI 诊断准确性研究（DASH）的 25 例患者，在发病后 1 周进行 DCE MRI 检查。使用对比剂在脑组织中的动力学和一般示踪剂动力学模型，估计 ROI 内和周围的正向漏出率（K(trans)），以及血肿对侧镜像 ROI（对照 ROI）。在所有患者中，与对侧镜像 ROI 相比，紧邻血肿的脑组织（即血肿边缘）的 BBB 通透性明显增加（P<0.0001）。大血肿（>30 mL）的 K(trans)值高于小血肿（P<0.005）。与深部出血相比，叶状出血的 K(trans)值明显更高（P<0.005），而与血肿体积无关。较高的 K(trans)值与更大的水肿体积相关。
DCE MRI 可测量和量化人类 ICH 紧邻血肿的脑组织中的 BBB 渗漏。较大的血肿以及叶状位置的血肿在 1 周时的 BBB 渗漏更大，与更大的水肿体积相关。
