Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, 100070, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Clin Neuroradiol. 2023 Sep;33(3):813-824. doi: 10.1007/s00062-023-01285-z. Epub 2023 Apr 25.
The aim of this study was to investigate the temporal evolution of perihematomal blood-brain barrier (BBB) compromise and edema growth and to determine the role of BBB compromise in edema growth.
Spontaneous intracerebral hemorrhage patients who underwent computed tomography perfusion (CTP) were divided into five groups according to the time interval from symptom onset to CTP examination. Permeability-surface area product (PS) maps were generated using CTP source images. Ipsilateral and contralateral mean PS values were computed in the perihematomal and contralateral mirror regions. The relative PS (rPS) value was calculated as a ratio of ipsilateral to contralateral PS value. Hematoma and perihematomal edema volume were determined on non-contrast CT images.
In the total of 101 intracerebral hemorrhage patients, the ipsilateral mean PS value was significantly higher than that in contralateral region (z = -8.284, p < 0.001). The perihematomal BBB permeability showed a course of dynamic changes including an increase in the hyperacute and acute phases, a decrease in the early subacute phase and a second increase in the late subacute phase and chronic phase. Perihematomal edema increased gradually until the late subacute phase and then slightly increased. There was a relationship between rPS value and edema volume (β = 0.254, p = 0.006).
The perihematomal BBB permeability is dynamic changes, and edema growth is gradually increased in patients following intracerebral hemorrhage. BBB compromise plays an essential role in edema growth. The quantitative assessment of BBB compromise may provide valuable information in therapeutic interventions of intracerebral hemorrhage patients.
本研究旨在探讨血肿周围血脑屏障（BBB）破坏和水肿生长的时间演变，并确定 BBB 破坏在水肿生长中的作用。
将接受 CT 灌注（CTP）检查的自发性脑出血患者根据发病至 CTP 检查的时间间隔分为五组。使用 CTP 源图像生成渗透率-表面积产物（PS）图。计算血肿周围和对侧镜像区域的同侧和对侧平均 PS 值。相对 PS（rPS）值计算为同侧与对侧 PS 值的比值。在非对比 CT 图像上确定血肿和血肿周围水肿的体积。
在总共 101 例脑出血患者中，同侧平均 PS 值明显高于对侧区域（z=-8.284，p<0.001）。血肿周围 BBB 通透性呈动态变化，包括在超急性期和急性期增加，在早期亚急性期减少，在晚期亚急性期和慢性期再次增加。血肿周围水肿逐渐增加，直到晚期亚急性期，然后略有增加。rPS 值与水肿体积之间存在相关性（β=0.254，p=0.006）。
血肿周围 BBB 通透性呈动态变化，脑出血患者的水肿生长逐渐增加。BBB 破坏在水肿生长中起着重要作用。BBB 破坏的定量评估可能为脑出血患者的治疗干预提供有价值的信息。
