1 Division of Neurology University of Alberta Edmonton Alberta Canada.
4 Division of Neurology University of Ottawa Ottawa Ontario Canada.
J Am Heart Assoc. 2019 Jun 4;8(11):e010904. doi: 10.1161/JAHA.118.010904.
Background Subacute ischemic lesions in intracerebral hemorrhage ( ICH ) have been hypothesized to result from hypoperfusion. Although studies of cerebral blood flow ( CBF ) indicate modest hypoperfusion in ICH , these investigations have been limited to early time points. Arterial spin labeling ( ASL ), a magnetic resonance imaging technique, can be used to measure CBF without a contrast agent. We assessed CBF in patients with ICH using ASL and tested the hypothesis that CBF is related to systolic blood pressure ( SBP ). Methods and Results In this cross-sectional study, patients with ICH were assessed with ASL at 48 hours, 7 days, and/or 30 days after onset. Relative CBF ( rCBF ; ratio of ipsilateral/contralateral perfusion) was measured in the perihematomal regions, hemispheres, border zones, and the perilesional area in patients with diffusion-weighted imaging hyperintensities. Twenty-patients (65% men; mean± SD age, 68.5±12.7 years) underwent imaging with ASL at 48 hours (N=12), day 7 (N=6), and day 30 (N=11). Median (interquartile range) hematoma volume was 13.1 (6.3-19.3) mL. Mean± SD baseline SBP was 185.4±25.5 mm Hg. Mean perihematomal rCBF was 0.9±0.2 at 48 hours at all time points. Baseline SBP and other SBP measurements were not associated with a decrease in rCBF in any of the regions of interest ( P≥0.111). r CBF did not differ among time points in any of the regions of interest ( P≥0.097). Mean perilesional rCBF was 1.04±0.65 and was unrelated to baseline SBP ( P=0.105). Conclusions ASL can be used to measure rCBF in patients with acute and subacute ICH . Perihematomal CBF was not associated with SBP changes at any time point. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00963976.
在颅内出血（ICH）中，亚急性缺血性损伤被认为是由低灌注引起的。尽管脑血流（CBF）的研究表明 ICH 中存在适度的低灌注，但这些研究仅限于早期时间点。动脉自旋标记（ASL）是一种磁共振成像技术，可在不使用造影剂的情况下测量 CBF。我们使用 ASL 评估了 ICH 患者的 CBF，并检验了 CBF 与收缩压（SBP）相关的假设。
在这项横断面研究中，ICH 患者在发病后 48 小时、7 天和/或 30 天进行 ASL 评估。在弥散加权成像高信号的患者中，在血肿周围区域、半球、边缘区域和病变周围区域测量相对 CBF（rCBF；同侧/对侧灌注的比值）。20 例患者（65%为男性；平均年龄±标准差为 68.5±12.7 岁）在 48 小时（N=12）、第 7 天（N=6）和第 30 天（N=11）进行 ASL 成像。中位数（四分位距）血肿体积为 13.1（6.3-19.3）mL。平均±标准差基线 SBP 为 185.4±25.5mmHg。在所有时间点，48 小时时的平均血肿周围 rCBF 为 0.9±0.2。基线 SBP 和其他 SBP 测量值与任何感兴趣区域的 rCBF 下降均无相关性（P≥0.111）。在任何感兴趣区域，rCBF 均未随时间点而变化（P≥0.097）。平均病变周围 rCBF 为 1.04±0.65，与基线 SBP 无关（P=0.105）。
ASL 可用于测量急性和亚急性 ICH 患者的 rCBF。在任何时间点，血肿周围 CBF 均与 SBP 变化无关。
