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Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage.
Cerebrovasc Dis. 2002; 14(3-4):214-20.CD

Abstract

Optimum blood pressure (BP) management in acute intracerebral hemorrhage (ICH) remains controversial. BP reduction may limit hematoma expansion, but may also exacerbate ischemia. Reduced regional cerebral blood flow (rCBF) has been reported in ICH. Its extent and precise pattern, however, remain uncertain. Dynamic single-section CT perfusion (CTP) is rapid, easily performed and offers superior spatial resolution to PET, SPECT and MRI. It may be the most applicable method for assessing the effects of BP management on rCBF in ICH. We sought to assess whether CTP can identify rCBF abnormalities in acute ICH in 5 patients with ICH who underwent CTP within 24 h of symptom onset. rCBF was measured in serially expanded 2-mm rings around the hematoma and compared with rCBF in the uninvolved hemisphere. Mean time to CTP was 9 h (range 3-23). Mean ICH volume was 25 ml (range 9-64). Perihematoma perfusion was reduced in all patients compared with contralateral hemisphere rCBF. rCBF reduction was most pronounced immediately adjacent to the hematoma (p < 0.05 at 2 mm, p = 0.084 at 4 mm, p > 0.2 at 6 and 8 mm). Perihematoma rCBF increased as a function of the distance from hematoma perimeter. Rate of rCBF increase over distance correlated with time from onset (p = 0.006). We conclude that CTP identifies a rim of reduced rCBF in ICH. A gradient of hypoperfusion appears to extend at least 4 mm beyond the hematoma edge and may be time dependent. Whether reduced CBF is associated with perihematoma ischemia requires additional study.

Authors+Show Affiliations

Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA. jrosand@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12403954

Citation

Rosand, Jonathan, et al. "Dynamic Single-section CT Demonstrates Reduced Cerebral Blood Flow in Acute Intracerebral Hemorrhage." Cerebrovascular Diseases (Basel, Switzerland), vol. 14, no. 3-4, 2002, pp. 214-20.
Rosand J, Eskey C, Chang Y, et al. Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage. Cerebrovasc Dis. 2002;14(3-4):214-20.
Rosand, J., Eskey, C., Chang, Y., Gonzalez, R. G., Greenberg, S. M., & Koroshetz, W. J. (2002). Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage. Cerebrovascular Diseases (Basel, Switzerland), 14(3-4), 214-20.
Rosand J, et al. Dynamic Single-section CT Demonstrates Reduced Cerebral Blood Flow in Acute Intracerebral Hemorrhage. Cerebrovasc Dis. 2002;14(3-4):214-20. PubMed PMID: 12403954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage. AU - Rosand,Jonathan, AU - Eskey,Clifford, AU - Chang,Yuchiao, AU - Gonzalez,R Gilberto, AU - Greenberg,Steven M, AU - Koroshetz,Walter J, PY - 2002/10/31/pubmed PY - 2003/1/7/medline PY - 2002/10/31/entrez SP - 214 EP - 20 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc. Dis. VL - 14 IS - 3-4 N2 - Optimum blood pressure (BP) management in acute intracerebral hemorrhage (ICH) remains controversial. BP reduction may limit hematoma expansion, but may also exacerbate ischemia. Reduced regional cerebral blood flow (rCBF) has been reported in ICH. Its extent and precise pattern, however, remain uncertain. Dynamic single-section CT perfusion (CTP) is rapid, easily performed and offers superior spatial resolution to PET, SPECT and MRI. It may be the most applicable method for assessing the effects of BP management on rCBF in ICH. We sought to assess whether CTP can identify rCBF abnormalities in acute ICH in 5 patients with ICH who underwent CTP within 24 h of symptom onset. rCBF was measured in serially expanded 2-mm rings around the hematoma and compared with rCBF in the uninvolved hemisphere. Mean time to CTP was 9 h (range 3-23). Mean ICH volume was 25 ml (range 9-64). Perihematoma perfusion was reduced in all patients compared with contralateral hemisphere rCBF. rCBF reduction was most pronounced immediately adjacent to the hematoma (p < 0.05 at 2 mm, p = 0.084 at 4 mm, p > 0.2 at 6 and 8 mm). Perihematoma rCBF increased as a function of the distance from hematoma perimeter. Rate of rCBF increase over distance correlated with time from onset (p = 0.006). We conclude that CTP identifies a rim of reduced rCBF in ICH. A gradient of hypoperfusion appears to extend at least 4 mm beyond the hematoma edge and may be time dependent. Whether reduced CBF is associated with perihematoma ischemia requires additional study. SN - 1015-9770 UR - https://www.unboundmedicine.com/medline/citation/12403954/Dynamic_single_section_CT_demonstrates_reduced_cerebral_blood_flow_in_acute_intracerebral_hemorrhage_ L2 - https://www.karger.com?DOI=10.1159/000065681 DB - PRIME DP - Unbound Medicine ER -