Contrast leakage distant from the hematoma in patients with spontaneous ICH: A 7 T MRI study

Abstract

Disruption of the blood–brain barrier (BBB) might play a role in the pathophysiology of cerebral small vessel disease-related ICH. The aim of this study was to assess presence and extent of contrast agent leakage distant from the hematoma as a marker of BBB disruption in patients with spontaneous ICH. We prospectively performed 7 tesla MRI in adult patients with spontaneous ICH and assessed contrast leakage distant from the hematoma on 3D FLAIR images. Thirty-one patients were included (mean age 60 years, 29% women). Median time between ICH and MRI was 20 days (IQR 9–67 days). Seventeen patients (54%; seven lobar, nine deep, one infratentorial ICH) had contrast leakage, located cortical in 16 and cortical and deep in one patient. Patients with contrast leakage more often had lobar cerebral microbleeds (CMBs; 77%) than those without (36%; RR 2.5, 95% CI 1.1–5.7) and a higher number of lobar CMBs (patients with contrast leakage: median 2, IQR 1–8 versus those without: median 0, IQR 0–2; p = 0.02). This study shows that contrast leakage distant from the hematoma is common in days to weeks after spontaneous ICH. It is located predominantly cortical and related to lobar CMBs and therefore possibly to cerebral amyloid angiopathy.

7T dynamic contrast‐enhanced MRI for the detection of subtle blood–brain barrier leakage

“…34 In another study, using FLAIR images of patients with spontaneous intracerebral hemorrhage, the extent of CA leakage distant from the hematoma was shown. 35 However, both studies did not correct for the vascular supply of the CA. A quantitative pharmacokinetic analysis of DCE-MRI requires a, preferably subjectspecific, VIF, which is ideally obtained from a cerebral artery.…”

“…In the first study, the contrast enhancement of active MS lesions revealed BBB opening with a T 1 ‐weighted DCE‐MRI sequence acquired at multiple, variable time‐points up to 30 min after CA administration 34 . In another study, using FLAIR images of patients with spontaneous intracerebral hemorrhage, the extent of CA leakage distant from the hematoma was shown 35 . However, both studies did not correct for the vascular supply of the CA.…”

Differences in cerebral small vessel disease magnetic resonance imaging markers between lacunar stroke and non–Lobar intracerebral hemorrhage

“…The FETCH study is a multi-center, prospective, cohort study amongst 204 adults that presented with a symptomatic spontaneous ICH confirmed by computed tomography (CT). 9 Patients underwent 3 T and/or 7 T MRI in one of three participating centers (University Medical Centers of Utrecht, Leiden or Nijmegen). Secondary causes were excluded by CT angiography in all and by digital subtraction angiogram if clinically indicated.…”

Non-Invasive Imaging of the Carotid Artery

“…In this consensus, plaque is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness > 1.5 mm. 41 People with irregular vessel walls might be more likely to harbor atherosclerotic vessel wall changes and thus might be more prone to develop symptoms, as compared to people with a smoothly thickened vessel wall, despite a similar mean IMT value. 42 In Chapter 2 we demonstrate that spatial inhomogeneity of CCA-IMT might be a measure for a more advanced atherosclerotic disease.…”

“…[38][39][40] IPH may be caused by erythrocyte extravasation from leaky newly formed vessels within the plaque. 41,42 Alternatively, several reports have shown a relation between small fissures in the fibrous cap and IPH, suggestive that IPH can also originate from hemorrhage from the lumen. 25,[43][44][45] IPH results in plaque destabilization because it associated with rapid plaque expansion and can induce a strong inflammatory response due to the degradation of hemoglobin.…”