Assessment of acute spontaneous intracerebral hematoma by CT perfusion imaging

Fainardi, Enrico; Borrelli, Massimo; Saletti, Andrea; Schivalocchi, Roberta; Russo, M.; Azzini, Cristiano; Cavallo, Claudio; Ceruti, Stefano; Chieregato, Arturo; Tamarozzi, Riccardo

doi:10.1016/s0150-9861(05)83164-5

Cited by 13 publications

(14 citation statements)

References 21 publications

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“…Supporting this theory, we found a positive correlation between the size of the area of reduced perfusion and the hematoma size. In agreement with the findings of Fainardi, 3 we found a moderate negative correlation between hematoma size and relative CBF (rϭϪ0.401, Pϭ0.02) and a positive correlation between hematoma size and dTTP (rϭ0.397, Pϭ0.02).…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with the literature. [1][2][3][4]7,8 Our perfusion values agree well with those reported for the perihemorrhagic area by Fainardi and coworkers who used perfusion CT 3 (relative CBF: 0.51; relative CBV: 0.61; dTTP: 1.2 seconds; relative values calculated by the authors from absolute values in 3 ) and with those from Zazulia and coauthors (relative CBF: 0.56) who used positron emission tomography. 1 The perfusion reduction is less pronounced than the one reported for infarcted tissue in acute ischemic stroke by König and colleagues (relative CBF: 0.51 versus 0.34; relative CBV: 0.62 versus 0.43; dTTP: 1.76 versus 4.8), 11 who used the same PCT method.…”

Section: Discussionsupporting

confidence: 89%

“…Two PCT studies and one using positron emission tomography reported clearly reduced perfusion surrounding acute intracerebral hemorrhage (ICH). [1][2][3] Of 5 studies using perfusion MRI, 4 -8 3 found a prolongation of the mean transit time, 4,7,8 whereas the other 2 did not find any perfusion change in the perihemorrhagic area. One of these studies, 6 however, found reduced values of the apparent diffusion coefficient indicative of ischemic damage.…”

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confidence: 94%

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Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography

Herweh

Jüttler

Schellinger

et al. 2007

Stroke

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Background and Purpose-Several recent studies analyzing perfusion changes in acute intracerebral hemorrhage fed the debate whether there is secondary ischemic tissue damage in the vicinity of intracerebral hemorrhage. We used perfusion CT to address this question. Methods-We examined 36 patients between 2001 and 2002 with acute intracerebral hemorrhage (within 24 hours after symptom onset). A subgroup of 8 patients was examined serially on day 1, between days 2 and 4, and after day 5. Nonenhanced CT images and maps of cerebral blood flow, cerebral blood volume, and time to peak were evaluated by region of interest analysis. Results-In comparison to the contralateral hemisphere, perfusion values were clearly reduced around the hematoma (relative values: cerebral blood flow 0.51, cerebral blood volume 0.62, time to peak 1.7 seconds). There was no difference in size between the area of reduced perfusion and the area of edema (5.17 versus 5.75 cm 2 , respectively) surrounding the hematoma. At time point 2, the edema grew significantly. Conclusions-In accordance with previous studies, we found reduced perfusion as well as edema surrounding acute intracerebral hemorrhage. Regarding ischemic tissue damage, we did not detect an initial mismatch between the perfusion deficit and the edema and therefore could not identify any tissue at risk of ischemia. We therefore interpret the reduced perfusion as a secondary phenomenon, ie, reduced oxygen demand of tissue damaged by pressure and clot components, not as the cause of any tissue damage associated with acute intracerebral hemorrhage.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 94%

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Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography

Herweh

Jüttler

Schellinger

et al. 2007

Stroke

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“…perfusion (Fainardi et al, 2005;Rosand et al, 2002), and positron emission tomography ) subsequently found perihematomal hypoperfusion but no evidence of perihematomal ischemic tissue. It is now thought that these areas of perihematomal hypoperfusion arise as a consequence of decreased metabolic demand as opposed to ischemia, as evidenced by a normal or reduced oxygen extraction fraction in perihematomal tissue measured by positron emission tomography imaging in acute clinical ICH (Schellinger et al, 2003;Zazulia et al, 2001).…”

Section: A Perihematomal Penumbramentioning

confidence: 96%

Experimental Intracerebral Hemorrhage: Avoiding Pitfalls in Translational Research

Kirkman

Allan

Parry‐Jones

2011

J Cereb Blood Flow Metab

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Intracerebral hemorrhage (ICH) has the highest mortality of all stroke subtypes, yet treatments are mainly limited to supportive management, and surgery remains controversial. Despite significant advances in our understanding of ICH pathophysiology, we still lack preclinical models that accurately replicate the underlying mechanisms of injury. Current experimental ICH models (including autologous blood and collagenase injection) simulate different aspects of ICH-mediated injury but lack some features of the clinical condition. Newly developed models, notably hypertension-and oral anticoagulant therapy-associated ICH models, offer added benefits but further study is needed to fully validate them. Here, we describe and discuss current approaches to experimental ICH, with suggestions for changes in how this condition is studied in the laboratory. Although advances in imaging over the past few decades have allowed greater insight into clinical ICH, there remains an important role for experimental models in furthering our understanding of the basic pathophysiologic processes underlying ICH, provided limitations of animal models are borne in mind. Owing to differences in existing models and the failed translation of benefits in experimental ICH to clinical practice, putative neuroprotectants should be trialed in multiple models using both histological and functional outcomes until a more accurate model of ICH is developed.

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“…Various imaging techniques are employed to study ongoing secondary neuronal injury in the perihematomal region, including positron emission tomography (PET), single photon emission computed tomography (SPECT), MR perfusion, and CT [19,[38][39][40][41][42][43][44][45][46][47][48]. Specifically, the results of PET studies have not shown evidence of hypoxia or ischemia (i.e., normal oxygen extraction fraction and 18 F-fluoromisonidazole uptake) surrounding the intraparenchymal hemorrhage.…”

Section: New Imaging Techniquesmentioning

confidence: 99%

Neuroimaging of Hemorrhage and Vascular Defects

2011

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Summary: Intracranial hemorrhage is the third most common cause of stroke and involves the accumulation of blood within brain parenchyma or the surrounding meningeal spaces. Accurate identification of acute hemorrhage and correct characterization of the underlying pathology, such as tumor, vascular malformation, or infarction, is a critical step in planning appropriate therapy. Neuroimaging studies are required not only for diagnosis, but they also provide important information on the type of hemorrhage, etiology, and the pathophysiological process. Historically, computed tomography (CT) scan has been the diagnostic imaging study of choice; however, there is growing evidence suggesting that magnetic resonance imaging (MRI) is at least as sensitive as CT to detect intraparenchymal hemorrhages in the hyperacute setting, and actually superior to CT in the subacute and chronic settings. Unique MRI and CT characteristics differentiate secondary causes of hemorrhage from the more common hypertensive hemorrhage. Baseline and serial studies can be used to identify patients who might benefit from acute interventions. In addition, new imaging modalities, (such as magnetic resonance spectroscopy, diffusion tensor imaging, and 320-row CT) are promising research techniques that have the potential to enhance our understanding of the tissue injury and recovery after intracranial hemorrhages.

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Assessment of acute spontaneous intracerebral hematoma by CT perfusion imaging

Cited by 13 publications

References 21 publications

Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography

Evidence Against a Perihemorrhagic Penumbra Provided by Perfusion Computed Tomography

Experimental Intracerebral Hemorrhage: Avoiding Pitfalls in Translational Research

Neuroimaging of Hemorrhage and Vascular Defects

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