Xu Haoli, Li Rui, Duan Yuxia, Wang Jincheng, Liu Shuailiang, Zhang Yue, He Wenwen, Qin Xiaotao, Cao Guoquan, Yang Yunjun, Zhuge Qichuan, Yang Jun, Chen Weijian
Molecular and Digital Medical Imaging Institute/Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, Zhejiang, 325000, China.
Zhenjiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbai Xiang Street, Ouhai District, Wenzhou, Zhejiang, 325000, China.
Neuroradiology. 2017 Jul;59(7):677-684. doi: 10.1007/s00234-017-1852-9. Epub 2017 Jun 3.
Blood-brain barrier (BBB) damage aggravates perihematomal edema, and edema volume predicts prognosis independently. But the BBB permeability at the late stage of acute intracerebral hemorrhage (ICH) patients is uncertain. We aimed to assess the BBB permeability of spontaneous basal ganglia ICH using computed tomographic perfusion (CTP) and investigates its relationship with hematoma and perihematomal edema volume.
We performed CTP on 54 consecutive ICH patients within 24 to 72 h after symptom onset. Permeability-surface area product (PS) derived from CTP imaging was measured in hematoma, "high-PS spot," perihematoma, normal-appearing, hemispheric, and contralateral regions. Hematoma and edema volumes were calculated from non-contrast CT.
"High-PS spot" and perihematoma regions had higher PS than the contralateral regions (p < 0.001). Hematoma PS was lower than that in the contralateral regions (p < 0.001). Perihematoma PS of the large-hematoma group was higher than that of the small-hematoma group (p = 0.011). Perihematomal edema volume correlated positively with hematoma volume (β = 0.864, p < 0.001) and perihematoma PS (β = 0.478, p < 0.001). Perihematoma PS correlated positively with hematoma volume (β = 0.373, p = 0.005).
Locally elevated perihematoma PS was found in most spontaneous basal ganglia ICH patients within 24 to 72 h after symptom onset. Perihematoma PS was higher in larger hematomas and was associated with larger edema volume. At this period, BBB leakage is likely to be an important factor in edema formation.
血脑屏障（BBB）损伤会加重血肿周围水肿，且水肿体积可独立预测预后。但急性脑出血（ICH）患者晚期的血脑屏障通透性尚不确定。我们旨在利用计算机断层扫描灌注（CTP）评估自发性基底节区脑出血患者的血脑屏障通透性，并研究其与血肿及血肿周围水肿体积的关系。
我们对54例症状发作后24至72小时内的连续ICH患者进行了CTP检查。从CTP成像中测量血肿、“高PS点”、血肿周围、外观正常、半球及对侧区域的通透性-表面积乘积（PS）。通过非增强CT计算血肿和水肿体积。
“高PS点”和血肿周围区域的PS高于对侧区域（p<0.001）。血肿PS低于对侧区域（p<0.001）。大血肿组的血肿周围PS高于小血肿组（p=0.011）。血肿周围水肿体积与血肿体积呈正相关（β=0.864，p<0.001），与血肿周围PS呈正相关（β=0.478，p<0.001）。血肿周围PS与血肿体积呈正相关（β=0.373，p=0.005）。
在症状发作后24至72小时内，大多数自发性基底节区脑出血患者血肿周围PS局部升高。较大血肿的血肿周围PS更高，且与更大的水肿体积相关。在此期间，血脑屏障渗漏可能是水肿形成的重要因素。
