Fainardi Enrico, Busto Giorgio, Bernardoni Andrea, Padovani Alessandro, Casetta Ilaria, Morotti Andrea
Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Florence, Italy.
Eur Radiol. 2025 Mar;35(3):1255-1264. doi: 10.1007/s00330-024-11243-z. Epub 2024 Dec 4.
We aimed to characterize the longitudinal evolution of perihematomal oligemia in acute intracerebral hemorrhage (ICH).
A single center prospectively collected cohort of 150 patients with primary spontaneous ICH were imaged with computed tomography perfusion within 6 h from onset (T0), at 24 h (T1) and at 7 days (T7). Perihematomal cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area and categorized into ischemic (< 20 mL/100 g/min), oligemic (20-39.9 mL/100 g/min), normal (40-55 mL/100 g/min) and hyperemic (> 55 mL/100 g/min).
pCBF values were ischemic in 20.7%, oligemic 47.3%, normal in 17.3%, and hyperemic in 14.7% of patients at T0. All patients with T0 ischemia remained ischemic at T7, normal and hyperemic patients at T0 maintained good perfusion values at T7, whereas 46.5% of oligemic patients at T0 developed delayed perihematomal ischemia. In patients with T0 perihematomal oligemia, the risk of conversion into delayed ischemia at T7 was higher in those with pCBF < 30 mL/100 g/min (p < 0.001). A total of 42.7% patients had perihematomal ischemia at T7 and this profile correlated with poor outcome, regardless of baseline perfusion status.
Our findings suggest that perihematomal oligemia may not represent a benign entity and indicate that delayed perihematomal ischemia is common and associated with unfavorable outcome.
Question The natural history and longitudinal evolution of perihematomal oligemia over time in patients with intracerebral hemorrhage (ICH) remains to be established. Findings Conversion of baseline perihematomal oligemia into ischemia occurs in 46.5% of oligemic ICH patients at 7 days, where a total of 42.7% patients were ischemic. Clinical relevance Evolution of perihematomal oligemia into ischemia during the transition from hyperacute to subacute phases is common. ICH patients with perihemorrhagic cerebral blood flow values < 30 mL/100 g/min are at high risk of ischemic progression, which in turn contributes to poor outcome.
我们旨在描述急性脑出血（ICH）患者血肿周围低灌注的纵向演变情况。
一个单中心前瞻性收集了150例原发性自发性ICH患者的队列，在发病后6小时内（T0）、24小时（T1）和7天（T7）进行了计算机断层扫描灌注成像。在手动勾勒出的血肿周围低密度区域测量血肿周围脑血流量（pCBF），并将其分为缺血性（<20 mL/100 g/min）、低灌注性（20 - 39.9 mL/100 g/min）、正常（40 - 55 mL/100 g/min）和充血性（>55 mL/100 g/min）。
在T0时，20.7%的患者pCBF值为缺血性，47.3%为低灌注性，17.3%为正常，14.7%为充血性。所有T0时为缺血性的患者在T7时仍为缺血性，T0时为正常和充血性的患者在T7时保持良好的灌注值，而T0时为低灌注性的患者中有46.5%发生了延迟性血肿周围缺血。在T0时存在血肿周围低灌注的患者中，pCBF < 30 mL/100 g/min的患者在T7时转变为延迟性缺血的风险更高（p < 0.001）。共有42.7%的患者在T7时存在血肿周围缺血，且这种情况与不良预后相关，无论基线灌注状态如何。
我们的研究结果表明，血肿周围低灌注可能并非良性情况，并表明延迟性血肿周围缺血很常见且与不良预后相关。
问题 脑出血（ICH）患者血肿周围低灌注随时间的自然史和纵向演变情况仍有待确定。发现 7天时，46.5%的低灌注性ICH患者基线血肿周围低灌注转变为缺血，共有42.7%的患者出现缺血。临床意义 在从超急性期向亚急性期过渡期间，血肿周围低灌注演变为缺血很常见。血肿周围脑血流量值<30 mL/100 g/min的ICH患者缺血进展风险高，这反过来导致不良预后。
